Most common early finding in Tuberous sclerosis complex is

(D) Ash leaf spot # Shagreen patch: is a connective tissue hamartoma located in the lower back region. A shagreen patch has an orange peel or leathery texture and often presents in children aged 2-6 years but may not appear until puberty in Tuberous sclerosis.> Axillary freckling: is the presence of flat, tan colored spots in the armpit area. Axillary freckles are sometimes referred to as Crowe's sign or cafe-au-lait macules and can be associated with a disease called neurofibromatosis type 1 (NF1).> Adenoma sebaceum: is a misnamed cutaneous disorder consisting of angiofibromas that begin in childhood and appear clinically as red papules on the face. Adenoma sebaceum may at times be associated with tuberous sclerosis. Gradually the papules become more prominent with time and persist throughout life> Hypomelanotic macules: are overwhelmingly the most common early finding in tuberous sclerosis complex. These hypopigmented lesions are described as ash-leaf spots. These are best observed using a Wood lamp. A Fitzpatrick patch or ash-leaf spot may be observed in the general population, but the presence of at least 3 spots constitutes one of the major diagnostic criteria of Tuberous sclerosis. (Ash leaf spot - often missed as a birth mark).