Skip to main content

Main menu

  • Home
  • Articles
    • Current
    • Published Ahead of Print
    • Archive
    • Supplemental Issues
    • Collections - French
    • Collections - English
  • Info for
    • Authors & Reviewers
    • Submit a Manuscript
    • Advertisers
    • Careers & Locums
    • Subscribers
    • Permissions
  • About CFP
    • About CFP
    • About the CFPC
    • Editorial Advisory Board
    • Terms of Use
    • Contact Us
  • Feedback
    • Feedback
    • Rapid Responses
    • Most Read
    • Most Cited
    • Email Alerts
  • Blogs
    • Latest Blogs
    • Blog Guidelines
    • Directives pour les blogues
  • Mainpro+ Credits
    • About Mainpro+
    • Member Login
    • Instructions
  • Other Publications
    • http://www.cfpc.ca/Canadianfamilyphysician/
    • https://www.cfpc.ca/Login/
    • Careers and Locums

User menu

  • My alerts

Search

  • Advanced search
The College of Family Physicians of Canada
  • Other Publications
    • http://www.cfpc.ca/Canadianfamilyphysician/
    • https://www.cfpc.ca/Login/
    • Careers and Locums
  • My alerts
The College of Family Physicians of Canada

Advanced Search

  • Home
  • Articles
    • Current
    • Published Ahead of Print
    • Archive
    • Supplemental Issues
    • Collections - French
    • Collections - English
  • Info for
    • Authors & Reviewers
    • Submit a Manuscript
    • Advertisers
    • Careers & Locums
    • Subscribers
    • Permissions
  • About CFP
    • About CFP
    • About the CFPC
    • Editorial Advisory Board
    • Terms of Use
    • Contact Us
  • Feedback
    • Feedback
    • Rapid Responses
    • Most Read
    • Most Cited
    • Email Alerts
  • Blogs
    • Latest Blogs
    • Blog Guidelines
    • Directives pour les blogues
  • Mainpro+ Credits
    • About Mainpro+
    • Member Login
    • Instructions
  • RSS feeds
  • Follow cfp Template on Twitter
  • LinkedIn
  • Instagram
OtherPractice

Answer: Can you identify this condition?

Lina Abdullah and Ossama Abbas
Canadian Family Physician December 2011; 57 (12) 1417;
Lina Abdullah
RN
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Ossama Abbas
MD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • eLetters
  • Info & Metrics
  • PDF
Loading

Answer to Dermacase continued from page 1415

3. Focal epithelial hyperplasia

First described in 1965, focal epithelial hyperplasia (FEH), also known as Heck disease, is a benign, proliferative cutaneous disorder that commonly affects the oral mucosa of children.1–4 Its prevalence is highest in Native and Inuit populations and it predominantly affects women and girls. Focal epithelial hyperplasia is clinically characterized by multiple asymptomatic, soft, mucosa-coloured papules or nodules (Figure 1), sometimes with lobulated or verrucose surfaces, on the lower lip, upper lip, buccal mucosa, and tongue (in order of decreasing frequency).1–4 Results of histology usually reveal focal parakeratosis, focal koilocytosis, and sparse perivascular lymphocytic infiltration of the superficial layer of the lamina propria.1–4 Cellular atypia and mitoses are typically absent. Results of a biopsy taken from the inner lip of our patient revealed similar characteristic findings.

Figure 1
  • Download figure
  • Open in new tab
Figure 1

The soft, mucosa-coloured papules characteristic of focal epithelial hyperplasia on the upper aspect of the labial mucous membrane in a 13-year-old boy

Although several factors, including genetics, malnutrition, and poor personal hygiene, might contribute to the development of FEH, the main predisposing factor is thought to be human papillomavirus infection, particularly types 13 and 32, which have frequently been detected in FEH lesions by polymerase chain reaction or in situ hybridization.1–4

Differential diagnosis

Clinical differential diagnosis of FEH includes irritation fibromas, mucosal neuromas, and white sponge nevus.5–7 Irritation fibromas usually present as soft, mucosa-coloured papules along the buccal occlusal line, as they usually arise secondary to irritation or masticatory trauma.5 Mucosal neuromas usually present in early childhood as multiple pink, pediculated papules or nodules on the mucosa of the lips and tongue.6 They often represent the earliest manifestation of multiple endocrine neoplasia syndrome type 2B, an autosomal dominant disorder also characterized, with varying frequency, by medullary carcinoma of the thyroid, pheochromocytoma, gastrointestinal ganglioneuromas, marfanoid features, and skeletal abnormalities.6 White sponge nevus is a rare autosomal dominant disorder caused by mutations in the keratin-13 gene.7 Clinically, it is characterized by bilateral white, soft, thick, spongy plaques, usually of the buccal mucosa. In difficult cases, histology might be required to make a distinction between FEH and white sponge nevus.7

Management

The clinical course of FEH is variable. Although some lesions resolve spontaneously over several months, others might persist indefinitely. In such cases, many possible treatments (including topical agents such as interferon or imiquimod, cryotherapy, electrocauterization, surgical excision, laser ablation, and systemic retinoic acid) have been tried with varying results.1–4 Our patient elected to have no treatment and his lesions resolved spontaneously within 3 months.

Footnotes

  • Competing interests

    None declared

  • Copyright© the College of Family Physicians of Canada

References

  1. ↵
    1. Archard HO,
    2. Heck JW,
    3. Stanley HR
    . Focal epithelial hyperplasia: an unusual oral mucosal lesion found in Indian children. Oral Surg Oral Med Oral Pathol 1965;20:210-2.
    OpenUrl
    1. Yasar S,
    2. Mansur AT,
    3. Serdar ZA,
    4. Goktay F,
    5. Aslan C
    . Treatment of focal epithelial hyperplasia with topical imiquimod: report of three cases. Pediatr Dermatol 2009;26(4):465-8.
    OpenUrlPubMed
    1. Bennett LK,
    2. Hinshaw M
    . Heck’s disease: diagnosis and susceptibility. Pediatr Dermatol 2009;26(1):87-9.
    OpenUrlPubMed
  2. ↵
    1. Steinhoff M,
    2. Metze D,
    3. Stockfleth E,
    4. Luger TA
    . Successful topical treatment of focal epithelial hyperplasia (Heck’s disease) with interferon-beta. Br J Dermatol 2001;144(5):1067-9.
    OpenUrlPubMed
  3. ↵
    1. Gonsalves WC,
    2. Chi AC,
    3. Neville BW
    . Common oral lesions: part II. Masses and neoplasia. Am Fam Physician 2007;75(4):509-12.
    OpenUrlPubMed
  4. ↵
    1. Cangiarella J,
    2. Jagirdar J,
    3. Adelman H,
    4. Budzilovich G,
    5. Greco MA
    . Mucosal neuromas and plexiform neurofibromas: an immunocytochemical study. Pediatr Pathol 1993;13(3):281-8.
    OpenUrlPubMed
  5. ↵
    1. Richard G,
    2. de Laurenzi V,
    3. Didona B,
    4. Bale SJ,
    5. Compton JG
    . Keratin 13 point mutation underlies the hereditary mucosal epithelial disorder white sponge nevus. Nat Genet 1995;11(4):453-5.
    OpenUrlCrossRefPubMed
PreviousNext
Back to top

In this issue

Canadian Family Physician: 57 (12)
Canadian Family Physician
Vol. 57, Issue 12
1 Dec 2011
  • Table of Contents
  • About the Cover
  • Index by author
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on The College of Family Physicians of Canada.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Answer: Can you identify this condition?
(Your Name) has sent you a message from The College of Family Physicians of Canada
(Your Name) thought you would like to see the The College of Family Physicians of Canada web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Answer: Can you identify this condition?
Lina Abdullah, Ossama Abbas
Canadian Family Physician Dec 2011, 57 (12) 1417;

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Respond to this article
Share
Answer: Can you identify this condition?
Lina Abdullah, Ossama Abbas
Canadian Family Physician Dec 2011, 57 (12) 1417;
Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • 3. Focal epithelial hyperplasia
    • Differential diagnosis
    • Management
    • Footnotes
    • References
  • Figures & Data
  • eLetters
  • Info & Metrics
  • PDF

Related Articles

  • Question: Can you identify this condition?
  • Question: Can you identify this condition?
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

Practice

  • Managing type 2 diabetes in primary care during COVID-19
  • Effectiveness of dermoscopy in skin cancer diagnosis
  • Spontaneous pneumothorax in children
Show more Practice

Dermacase

  • Question: Can you identify this condition?
  • Answer: Can you identify this condition?
  • Question: Can you identify this condition?
Show more Dermacase

Similar Articles

Navigate

  • Home
  • Current Issue
  • Archive
  • Collections - English
  • Collections - Française

For Authors

  • Authors and Reviewers
  • Submit a Manuscript
  • Permissions
  • Terms of Use

General Information

  • About CFP
  • About the CFPC
  • Advertisers
  • Careers & Locums
  • Editorial Advisory Board
  • Subscribers

Journal Services

  • Email Alerts
  • Twitter
  • LinkedIn
  • Instagram
  • RSS Feeds

Copyright © 2025 by The College of Family Physicians of Canada

Powered by HighWire