Focal epithelial hyperplasia, also known as Heck’s disease is an asymptomatic, benign neoplastic condition characterized by multiple white to pinkish papules that occur diffusely in the oral cavitydue to human papillomavirus (HPV).

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Aetiology

Agent:

• HPV types 13 & 32

Risk factors:

• Poor hygiene, poverty and community lifestyles
• Immunocompromised patients

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Clinical features

FEH affects only the lining of the mouth, most often: inside the lips inside the cheeks sides of the tongue, in the form of a smooth, slightly elevated and slightly elevated aspect. 

• Usually asymptomatic
• Gums and tonsils can also to be involved.
• Usually same color as the rest of the mouth, but sometimes paler.
• Often several lesions < 1 cm in diameter

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Diagnosis

Investigations

• Detection of HPV 13 or 32 DNA after PCR on scrapings taken from a lesion

Biopsy:

• In situ hybridization of biopsy specimens.
• Histopathology: Thickened epithelium, elevated above the surrounding mucosa + elongated rete ridges with mitosoid bodies

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Management

• Spontaneously regress without treatment
• Excisional biopsy (functional or aesthetic concern)