Foliar depigmentation is most commonly seen in tuberous sclerosis and is one of its clinical manifestations as an oval, striated, lobe-shaped hypopigmented spot. The disease is autosomal dominant, and disseminated cases are also common. The gene is localized at 9q34 or 16q13,3, a tumor suppressor gene, and the gene products are hamartin and tuberin, respectively, both of which regulate cell growth. So what tests can be done to confirm the diagnosis? 1. Skin changes. It is mainly sebaceous adenoma on the face. 2. Neurological signs and symptoms. They are epilepsy and mental retardation. 3.Ocular changes. The most common are optic papillae and retinal nodules. Diagnosis: The diagnosis of sebaceous adenoma, mental retardation and epilepsy can be confirmed by the presence of the three main signs. However, the three main signs may not always appear together in clinical practice. Sebaceous adenoma, which is seen in almost all patients; fundus lesions are often found during ophthalmologic consultations after the diagnosis of sebaceous adenoma is confirmed. Lobular depigmentation easily confused symptoms Cyanotic skin around the umbilicus: In acute pancreatitis, the overflowing pancreatic fluid contains a large amount of pancreatic enzymes spreading along the tissue interstices, seeping into the subcutis and dissolving the subcutaneous fat, causing the capillaries to rupture and bleed, resulting in cyanosis of the skin around the umbilicus called Cullen’s sign. In addition to purple skin around the umbilicus and the lateral abdominal wall, there can also be skin damage on the extremities in the form of purple spots, blisters and necrosis, and skin damage is one of the signs of critical condition. The abdominal wall manifestations of acute pancreatitis are part of the systemic disease, and signs and symptoms such as abdominal wall edema, pressure pain, and skin color changes can be seen clinically. Freckles: It is a simple light brown or brown skin spot, mostly growing on the face. The formation of freckles is mainly due to the excessive melanin produced by melanocytes in the basal layer of the skin epidermis.