Focal epithelial hyperplasia

Heck’s disease

An asymptomatic, benign neoplastic condition characterized by multiple white to pinkish papules that occur diffusely in the oral cavity.

Affects oral mucosa, gingiva, tongue, and lips.

Characterized by multiple, small circumscribed, clustered papules or raised plaques.

Rarely affects anal, genital and anal mucosa.

Lesions usually painless.

Patients present with slightly pale, smooth or roughened surface morphology.

Caused by the human papilloma virus types 13 and 32, but other HPV types have been implicated.

Surface cells have vacuolated cytoplasm around irregular, pyknotic nuclei and occasional cells with mitosis-like changes within otherwise mature and well-differentiated epithelium.

Histologically associated with parakeratosis, epithelial hyperplasia, focal acanthosis,

fusion, and elongated rete ridges.

First identified in the Aboriginal population.

Seen more commonly among Eskimos, and Native Americans.

Relatively rare in white, Asian, and African Americans.

Primarily affects children and adolescents.

Contributing factors include: poor hygiene, malnutrition, and AIDS.

Lesions spontaneously regress without treatment.

Diagnosis is clinical and confirmed by biopsy and detection of HPV.

Possible treatment may be excisional biopsy for lesions of functional or aesthetic concern.

Treatment includes surgical excision, cryotherapy, carbon dioxide laser topical interferon and imiquimod.

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