Multidisciplinary team improved effective and global outcome in a patient with tuberous sclerosis

We present a case report of a young woman with disfiguring facial angiofibromas, affected by tuberous sclerosis and depression. Depression and embarrassment, caused by her facial lesions forced her to refuse to go out, avoiding the vital dialysis appointments. Thus an aesthetic problem created a survival problem. Physicians performed a prospective global functioning evaluation of a depressed, disfigured patient, not focusing to a parceled aspect such as anxiety, satisfaction or depression. After preliminary physician examinations the woman was operated to the face, obtaining excellent aesthetic results. Monthly a psychiatric evaluation was performed. With these synergic treatments the patient obtained a big improvement of aesthetic conditions and global functioning, she re-attended to dialysis and improved her relational approach. GAF (Global Assessment Functioning) scale score improved from the 61 to 71. We decided to report only GAF scale in order to underline the aspect of a global improvement. Previous studies about tuberous sclerosis and dermatological treatment often reported a parceled patient’s view. In conclusion, for the first time in literature we performed a global evaluation of the patient’s functioning, demonstrating how a surgical-dermatological treatment can improve the psychological, social and somatic features in a patient with tuberous sclerosis, but only with a concurrent mood evaluation and support.