Forehead plaques, smooth patches of slightly raised skin with a reddish or yellowish discoloration, can be the earliest skin manifestation of tuberous sclerosis (TS) according to the authors who describe 2 patients seen at Bath and Bristol, UK., presenting with infantile spasms at 3 and 5 months of age. [1]

COMMENT: Early diagnosis of tuberous sclerosis (TS) is important for genetic counselling and prognostic predictions. The prevalence of TS in patients with infantile spasms has been estimated at 25% or higher in some series. A Wood’s light examination of the skin for hypopigmented maculae, a more frequent characteristic dermatologic manifestation of TS, is important in all infants with myoclonic spasms and hypsarrhythmia.