Table 2.

Treatment options for skin, mucocutaneous and dental manifestations in patients with TSC

Conditions	Treatment Consideration	Limitations
Facial Angiofibroma	Topical mTOR inhibitor Only case studies or case series are available Well tolerated; no systemic toxicity reported Rapid response in weeks after initiating treatment May be more efficacious for small, early lesions and for preventing recurrence after surgery Clinical trial results pending  Laser surgery Consider PDL laser for erythematous lesions; effect maybe enhanced in combination with ALA Consider ablative laser for fibrotic lesions  Surgical excision Should be considered for symptomatic, large lesions May be considered for single or fewer fibrotic lesions	Costly Continuous treatment needed Temporary improvement Invasive Costly Sedation maybe needed
Cephalic Fibrous Plaque	Surgical intervention may be considered if rapidly progressing and/or disfiguring	Sedation needed Surgical risks
Skin Tags	Treatment usually not necessary Snip excision if symptomatic
Hypo-pigmented Macules	Treatment generally not necessary Case study showed improvement with topical mTOR inhibitor; may be considered for cosmetic sensitive area on the face	Cost Long-term treatment may be necessary
Ungual Fibroma	Treatment is considered for incidental trauma Topical mTOR inhibitor maybe considered for small lesions Ablative laser or surgical excision may be considered if the lesions are symptomatic and larger than 3 mm in size	Repeat treatment may be needed Invasive
Intraoral Fibroma	First line, good oral hygiene to minimize irritation Consider electric cautery, ablative laser or surgical excision if obstructive	Sedation maybe needed
Dental Pits	First line intervention, good dental hygiene Restoration may be considered if at risk of dental caries
Jaw Cysts	Curettage Surgical excision if at risk for bony destruction	General anesthesia needed