Heck’s disease, also known as focal epithelial hyperplasia, is a rare viral infection that primarily affects the oral cavity. It is characterized by the appearance of small, painless papules or plaques on the mucous membranes inside the mouth. This condition is considered benign and generally does not pose a significant health threat, often being asymptomatic.
What is Heck’s Disease?
Heck’s disease is caused by specific types of the human papillomavirus (HPV), typically types 13 and 32. These HPV subtypes specifically target the mucosal epithelium, leading to the characteristic lesions. The virus induces the proliferation of epithelial cells, which results in the hyperplastic lesions observed in the disease.
The lesions commonly appear as small, soft, and painless papules or plaques, typically measuring a few millimeters in diameter. They can be single or multiple and may present with a smooth or slightly roughened surface, sometimes forming a “cobblestone” appearance. While these growths can be found anywhere in the oral cavity, they are most frequently located on the buccal (inner cheek) mucosa, labial (lip) mucosa, and the tongue.
Heck’s disease is observed globally but shows a higher prevalence in certain populations. Factors such as poor oral hygiene, crowded living conditions, and a compromised immune system may contribute to its development.
How Heck’s Disease is Diagnosed and Its Typical Course
Diagnosis of Heck’s disease is primarily based on a clinical examination of the oral lesions. A healthcare professional will visually inspect the papules or plaques and consider their appearance and distribution. The condition often presents with a distinctive clinical picture, especially in populations where it is more common.
To confirm the diagnosis, a biopsy of the lesion is often performed, followed by a histopathological examination. This microscopic analysis reveals characteristic epithelial hyperplasia and the presence of koilocytes, which are cells with perinuclear cytoplasmic vacuolation, a hallmark of HPV infection. In some cases, particularly for children, a mucosal scraping may be used to detect specific HPV 13 or 32 DNA through polymerase chain reaction (PCR), which can confirm the diagnosis without a more invasive biopsy.
Heck’s disease is generally asymptomatic, meaning it causes no pain or discomfort, although mild irritation may occur in some instances. The condition is benign and often resolves spontaneously without intervention over a period ranging from a few months to several years. There is no tendency for these lesions to transform into malignant (cancerous) growths.
Management and Treatment Options
Treatment for Heck’s disease is usually not necessary because the condition is benign and frequently regresses on its own. Observation is often recommended, particularly if the lesions are asymptomatic and not causing any functional issues. This approach allows for the natural resolution of the papules over time.
Treatment may be considered if the lesions cause aesthetic concerns, discomfort, or interfere with oral functions such as eating or speaking. Various methods can be employed to remove the lesions:
Surgical excision
Cryotherapy
Laser ablation
Electrocautery
Topical applications like 25% podophyllin resin or imiquimod 5% cream
While treatments can effectively remove the lesions, recurrence is possible even after spontaneous regression or intervention.