Hypopigmentation Shape and Location Change

[TSC Mum]

In a child with a possible diagnosis of tuberous sclerosis, with only 3 areas of hypopigmentation, one small confetti scattering, and moderate mental disability, would the fact that the 3 areas are ash-leaf shaped carry more significance than if they were another shape?  2 of these areas were on the back/trunk 2 years ago and at last dermatologic checkup those 2 areas no longer appeared under Wood's Lamp, however, there were 2 definite ash-leaf shapes on the left calf.  Is it possible for areas of hypopigmentation to change like this in tuberous sclerosis?

[Alan Rockoff, MD]

To be frank, I don't have enough personal clinical experience with tuberous sclerosis to be able to comment.  A pediatrician with experience taking care of kids with the condition would be more likely to know.  However, I will say that I doubt that fluctuations in intensity or shape of whiteness have much meaning.  If the diagnosis isn't certain, you might want to get another opinion, or you might have to wait some time until the condition clarifies itself.

Best.

Dr. Rockoff