Heck’s disease

A 7-year-old girl presented with a 10-month history of the development of multiple, non-tender, sessile, soft papules, plaques, and nodules with a flat-topped, pink to pale, grainy surface on her oral mucosa. She was otherwise completely healthy. Her family history was nonsignificant. She was diagnosed with Heck’s disease, also known as focal epithelial hyperplasia, a benign condition of the oral cavity that has a predilection for native Indians from North and South America, Eskimos, and South Africans of Khoi-Shan extraction. There is a strong association with HPV types 13 and 32, which are found in over 90% of biopsied lesions.^1,2 In addition, a genetic predisposition and an immunocompromised host status, due to malnutrition and crowded living conditions, are thought to be contributing factors. Focal epithelial hyperplasia shows a female predilection and is typically observed in the first two decades of life.^1,3 Clinically, the disease is characterized by multiple, non-tender, sessile, soft papules, plaques, and nodules with a flattopped, pink to pale, grainy surface. Diffuse, multifocal mucosal involvement of the labial and buccal mucosa and lateral tongue is the classic presentation. Although papulonodular eruption is the most common presentation, a papillomatous pattern with a pale or white surface may be observed on the lateral tongue and buccal mucosa.¹ The lesions of focal epithelial hyperplasia spontaneously resolve in some patients within a few months to several years. Conservative surgical excision may be performed for aesthetic or functional purposes. Other treatment modalities with variable effectiveness have included cryotherapy, carbon dioxide laser ablation, topical application of 25% podophyllin resin, and vitamin therapy.⁴ Recurrence of these oral lesions, even following spontaneous regression, is not uncommon.

Figure 1.

Papules, plaques and nodules indicative of Heck’s disease in a 7-year-old girl.