Disease shagreen patches are firm yellowish-red or pink nodules slightly elevated above the surrounding skin. The surface of a shagreen patch is often described as having the texture of an orange peel. Shagreen patches vary in size from a few millimeters to more than 10 cm in diameter. If present, they are nearly always found on or around the lumbar region of the back. They typically first appear before or around puberty, but are sometimes seen in children as young as six months old. The patches may increase in number over time and typically grow in proportion to body size until adulthood.