Although Simon et al,1 in the "Picture of the Month" in the September 1995 issue of the Archives, correctly indicate that Waardenburg syndrome and piebaldism may be present, they did leave out an additional, but critical, possibility. I think that an additional diagnosis should be considered when a new-born is noted to have a white patch of hair.
In 1978, McWilliam and Stephenson2 reported their findings in 4 infants, all born with a white patch of hair on the scalp, who subsequently were found to have tuberous sclerosis. In these infants, additional findings of tuberous sclerosis, such as ovoid ("ash-leaf") hypopigmented skin areas, cafe-au-lait spots, hamartomatous skin lesions, and brain lesions did not develop until months to years later. This report first had come to my attention in 1985 when I myself had seen an infant with a nearly identical patch of white hair as that shown by