Focal epithelial hyperplasia (Heck’s disease)

Focal epithelial hyperplasia (FEH) or Heck’s disease is a rare disease of the oral mucosa; it can be mostly found in children or young adults, immunosuppressed and who live in regions with low socioeconomic status. It is characterized by asymptomatic papules on the oral mucosa, gingiva, tongue, and lips¹. Healing can be spontaneous, and the treatment is indicated if there are aesthetic or functional complications. Human papillomavirus (HPV), especially genotypes 13 and 32, have been associated with FEH and detected in the majority of lesions². Histopathologically FEH is characterized by parakeratosis, epithelial hyperplasia, focal acanthosis, fusion and horizontal outgrowth of epithelial ridges³. Here it is described the case of a 40-year-old male patient, HIV-positive, smoker with numerous, asymptomatic oral papules clinically and histologically corresponding to FEH. Labial and buccal mucosa were especially affected by lesions. The treatment was performed using KTP laser 532nm, in continuous mode with a 300mm fiber, power 1,4W (power density 1980.22 W/cm²). After anaesthesia without vasoconstrictor the lesions was tractioned with suture or Allis clamp and then completely excised. The lesions were preserved in 10% formalin for histological examination, that confirmed the clinical diagnosis of FEH. In this case the laser has allowed an excellent control of bleeding, without postoperative suture, and optimal wound healing.