Which among the following is the earliest feature of Tuberous sclerosis?

Ash leaf spots are white, ovoid, hypopigmented, ash leaf-shaped macules that can be found on the trunks or limbs. White macules offer an excellent oppounity for early diagnosis because they may be found at bih or early infancy. Shagreen patches are flesh-colored soft plaques that are frequently found in the lumbosacral area but may occur anywhere on the trunk. The surface may be pebbly (resembling pigskin or untanned leather) with prominent follicular openings. They are usually noticed during the first decade. The characteristic lesions are angiofibromas. These are pink or skin-colored telangiectatic papules commonly observed in the nasolabial folds and on the cheeks and chin. They usually appear in children younger than 10 years and increase in size and number until adolescence, remaining unchanged thereafter. Other areas in which they may be observed include in and around nails (ungual fibromas), scalp, and forehead, lips, dorsa of tongue, and palate.