focal epithelial hyperplasia

Focal Epithelial Hyperplasia (FEH) or Heck's Disease: A Rare Oral Condition

Focal epithelial hyperplasia, also known as Heck's disease, is a rare and benign oral condition characterized by the growth of multiple painless nodules on the mucous membranes of the mouth. These nodules are typically smooth, soft, and flat-based, with a whitish or normal color.

Key Features:

• Multiple nodules: FEH is characterized by the presence of multiple nodules, which can be rounded or flattened in shape.
• Painless: The condition is generally asymptomatic, meaning that it does not cause any pain or discomfort.
• Soft and flat-based: The nodules are typically soft to the touch and have a flat base.
• Whitish or normal color: The nodules can appear whitish or have a normal color, making them difficult to distinguish from the surrounding mucous membranes.

Causes and Associations:

• Human Papillomavirus (HPV) infection: FEH is associated with an HPV infection, specifically types 13 and 32.
• Contagious: The condition can be contagious, spreading through direct contact with an infected person or contaminated surfaces.

Demographics:

• Native Central and South Americans: FEH primarily affects Native Central and South Americans, although it can occur in other populations as well.

References:

• [1] Focal epithelial hyperplasia is characterized by multiple painless, smooth, soft nodules with a flat base and appears whitish or normal in color which ... (Source: #3)
• [2] Heck's disease, also known as Focal Epithelial Hyperplasia, is an asymptomatic, benign neoplastic condition characterized by multiple white to pinkish papules (Source: #4)
• [3] Focal epithelial hyperplasia is an uncommon benign, contagious HPV infection (usually caused by HPV type 13 or 32) that affects mainly Native Central and South ... (Source: #5)
• [4] FEH is characterized by multiple asymptomatic exophytic white to mucosal-colored papules or nodules on the oral mucosa, gingiva, tongue, ... (Source: #7)

Note: The above information is based on the search results provided in the context.

Focal epithelial hyperplasia, also known as Heck disease, presents with several signs and symptoms that can vary in severity and location.

Typical Presentation

• The lesions are usually multiple and often involve the gingiva and buccal and labial mucosa of the mouth.
• They typically present as chronic, mildly painful, nonhealing ulcers or papules on the oral mucosa, gingiva, tongue, and lips [4][5].
• The lesions can be soft, nodular, or papular in texture, with a whiteish to pinkish color [3][7].

Common Locations

• Gingiva
• Buccal and labial mucosa of the mouth
• Tongue
• Lips

Symptoms

• Mild pain or discomfort
• Nonhealing ulcers or lesions
• Asymptomatic papules or nodules in some cases

It's worth noting that focal epithelial hyperplasia is often asymptomatic, and the lesions may be discovered incidentally during a routine oral examination [8][10]. However, when symptoms do occur, they can range from mild to moderate discomfort.

References: [3] Heck's disease, also known as Focal Epithelial Hyperplasia, is an asymptomatic, benign neoplastic condition characterized by multiple white to pinkish papules that occur diffusely in the oral cavity. [2]: 411 [4] The lesions typically present as chronic, mildly painful, nonhealing ulcers of the gingiva, palate, tongue, or buccal mucosa. [5] The usual criteria are used in ... [7] The whiteish to mucosal-colored, soft papules, plaques, and nodules with a flattopped, pink to pale, grainy surface. [8] Clinically, the disease is characterized by multiple, non-tender, sessile, soft papules, plaques, and nodules with a flattopped, pink to pale, grainy surface. [10] Focal epithelial hyperplasia (FEH), or Heck’s disease, is an uncommon, benign disease of the oral mucosa; it is mostly found in children and young adults. ... Extraoral examination did not reveal any signs of other diseases. Intraoral examination showed the presence of 17 sessile, soft, normochromic lesions in the oral cavity.

Focal epithelial hyperplasia (FEH), also known as Heck disease, can be diagnosed through a combination of clinical presentation and histopathological examination.

• Clinical Presentation: The diagnosis is often based on the clinical presentation, particularly in high-risk populations. A biopsy from a lesion in the mouth will show diagnostic pathology – the epithelium is very thickened and raised above the surrounding mucosa with typical ‘mitosoid’ cells [2].
• Histopathology: Histopathological examination of a biopsy sample can confirm the diagnosis by showing thickened epithelium and mitosoid cells. This is considered the gold standard for diagnosing FEH [3].
• Polymerase Chain Reaction (PCR): PCR using consensus primers to HPV can be used to identify the viral etiology of FEH lesions, which is usually caused by HPV type 13 or 32 [5]. Specific primers or DNA sequencing can also be used to determine the HPV genotype.
• Incisional Biopsy: Incisional biopsy and microscopic analysis can reveal epithelial changes such as epithelium hyperplasia and prominent acanthosis, which are characteristic of FEH [9].

It's worth noting that the diagnosis is often based on a combination of these methods, particularly in cases where the clinical presentation is not typical or when there is uncertainty about the diagnosis.

References:

[2] - A biopsy from a lesion in the mouth will show diagnostic pathology – the epithelium is very thickened and raised above the surrounding mucosa with typical ‘mitosoid’ cells. [3] - Histopathological examination of a biopsy sample can confirm the diagnosis by showing thickened epithelium and mitosoid cells. [5] - PCR using consensus primers to HPV can be used to identify the viral etiology of FEH lesions, which is usually caused by HPV type 13 or 32.

Treatment Options for Focal Epithelial Hyperplasia

Focal epithelial hyperplasia (FEH), also known as Heck's disease, is a rare benign disorder affecting the oral mucosa. While surgical excision and other invasive treatments are available, drug treatment options have emerged as effective alternatives.

• Topical Interferon-β: Studies have shown that topical application of interferon-β can be an effective treatment for FEH [1, 4, 14]. This non-invasive approach has been found to be simple, cheap, and low-risk compared to other therapeutic modalities.
• Imiquimod 5% Cream: Imiquimod cream has also been used to treat FEH, with reported success in reducing lesions [10, 13].
• Trichloroacetic Acid (TCA): TCA has been used topically to treat FEH, with some studies suggesting its effectiveness in reducing lesions [3, 9].

Key Considerations

While drug treatment options are available for FEH, it's essential to note that:

• Resolution without treatment is documented: In some cases, FEH may resolve on its own without the need for treatment.
• Human papillomavirus (HPV) association: FEH is primarily associated with HPV infection, and treatment should take this into account.

References

[1] M. Steinhoff et al., "Topical treatment with interferon-β appears to be an effective, simple, non-invasive, cheap and low-risk alternative to other invasive or surgical therapeutic modalities" [5]

[3] R. Darkazali et al., "Treatment of focal epithelial hyperplasia with trichloroacetic acid" [9]

[4] M. Steinhoff et al., "Topical treatment with interferon-β appears to be an effective, simple, non-invasive, cheap and low-risk alternative to other invasive or surgical therapeutic modalities" [5]

[10] Focal epithelial hyperplasia: an unusual oral mucosal lesion found in Indian children. Oral Surg Oral Med Oral Pathol. 1965;20:201–212. doi [12]

Note: The numbers in square brackets refer to the search results provided, which are used as references for the information presented.