Skin lesions including on the face, body and nails are found in virtually all of patients with TSC. The earliest sign may be white skin patches (hypomelanotic macules), which are best seen under Wood's lamp (ultraviolet light). They can be seen from birth and do not cause any problems. As the child grows older, a characteristic facial rash across the nose and cheeks in a butterfly distribution, called facial angiofibroma, may appear. During adolescence or later, small fibromas or nodules of skin may form around finger or toenails. Finally, a shagreen patch, patch of skin that is flesh-colored and dimpled like an orange peel, may be found on the lower back.

None of the skin lesions result in serious medical problems. Among the skin lesions, the facial angiofibromas cause the most disfigurement because of their location. There are a variety of treatment options possible for this rash, as such consultation with a dermatologist may be desired.