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http://www.kidney-international.org & 2009 International Society of Nephrology
Kidney International (2009) 75, 1364; doi:10.1038/ki.2008.440
Shagreen patch Antonio Granata1 and Renzo Mignami2 1
Department of Nephrology and Dialysis, ‘Vittorio Emanuele’ Hospital, Catania, Italy and 2Department of Nephrology and Dialysis, ‘Infermi’ Hospital, Rimini, Italy Correspondence: Antonio Granata, Department of Nephrology and Dialysis, ‘Vittorio Emanuele’ Hospital, Via Plebiscito No. 628, Catania I-95024, Italy. E-mail:
[email protected]
Figure 1 | A typical shagreen patch on the lower back.
Figure 2 | A slightly elevated soft skin-colored patch of irregular shape and thickness.
A 19-year-old previously healthy woman was referred for microhematuria and moderate hypertension. Skin examination revealed flesh-colored periungual fibromas (Koenen’s tumors) on proximal nails and a plaque measuring 11 7 cm consistent with a shagreen patch on the lower back (Figures 1 and 2). Ultrasound of the abdomen revealed multiple small renal angiomyolipomas and brain magnetic resonance showed multiple subependymal nodules. A diagnosis of tuberous sclerosis complex was made.
A shagreen patch (arrows) is an irregularly shaped, irregularly thickened, slightly elevated soft skin-colored patch, usually on the lower back, made up of excess fibrous tissue. It is found in approximately 40% of tuberous sclerosis complex patients, is characteristic of tuberous sclerosis complex, and is considered to be a major feature in the tuberous sclerosis complex diagnostic criteria. Although often quite large, shagreen patches are generally hidden by clothing and rarely cause disfigurement. Larger or more protuberant lesions may cause discomfort or rub on clothing, and may require surgery.
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Kidney International (2009) 75, 1364
