Table 2

Treatment options for tuberous sclerosis complex–associated skin, mucocutaneous and dental manifestations13

Condition	Treatment options		Additional considerations
Facial angiofibroma	Topical mTOR inhibitors	▸ Rapid response in weeks after initiating therapy ▸ May be more effective for small early lesions and for preventing recurrence after surgery ▸ Well tolerated with no systemic toxicity	▸ Continual therapy necessary
	Vascular laser surgery	▸ Consider pulsed-dye laser for erythematous lesions ▸ Effect may be enhanced when combined with 5-aminolevulinic acid	▸ Temporary improvement
	Ablative laser surgery	▸ Consider for fibrotic lesions	▸ Sedation or general anaesthesia may be necessary
	Surgical excision	▸ Consider for symptomatic large lesions ▸ Also consider for single or fewer fibrotic lesions	▸ Sedation may be necessary
Fibrous cephalic plaque	Surgical intervention	▸ Consider if rapid progression and/or disfiguring	▸ Sedation may be necessary ▸ Surgical risks
Skin tags	Snip excision	▸ Treatment usually not necessary, but consider if symptomatic	▸ Minimal surgical risk
Hypomelanotic macules	Topical mTOR inhibitors	▸ Treatment usually not necessary, but consider for cosmetic sensitive area on the face	▸ Long-term treatment may be necessary ▸ High cost
Periungual/subungual fibroma	Ablative laser	▸ Consider if lesions symptomatic or >3 mm	▸ Repeated treatment may be necessary
Periungual/subungual fibroma	Surgical excision	▸ Consider if lesions symptomatic or >3 mm	▸ Repeated treatment may be necessary
Intraoral fibroma	Good oral hygiene	▸ To minimise irritation	▸ None
Intraoral fibroma	Other options	▸ If obstructive, consider electrocautery, ablative laser or surgical excision	▸ Sedation may be necessary
Dental pits	Good dental hygiene	–	▸ None
Dental pits	Restoration	▸ Consider if at risk for dental caries	▸ Sedation may be necessary
Jaw cysts	Curettage, surgical excision	▸ Consider if at risk for bony destruction	▸ Sedation may be necessary

mTOR, mammalian target of rapamycin.