Dermoscopy of focal epithelial hyperplasia

Focal Epithelial Hyperplasia

“…A diagnosis of FEH is often based solely on clinical presentation and histopathology, while the HPV involvement is rarely assessed [ 2 , 5 , 6 , 9 , 13 , 17 , 29 ]. Distinct pathognomonic findings include koilocytosis with clear cytoplasm, epithelial hyperplasia with parakeratosis and acanthosis, widened and thickened rete ridges, ballooning degeneration and mitosoid bodies (example of the latter in Figure 1 c) [ 7 , 30 ].…”

“…In 2001–2019, this number had risen to 20 published cases [ 1 ]. From 2020–2021, two cases were reported within the European region [ 4 , 17 ], while several reports were published around the world, with many of them from the United States [ 8 , 9 , 11 , 15 , 34 ]. This increase in the registration of FEH cases is likely influenced by the individual healthcare systems in the varying countries; however, as the disease is mostly asymptomatic, cases cannot be expected to be systematically documented.…”

“…In Greenland, the Danish medical doctor Helms described symptoms associated with FEH among the indigenous population back in 1894 [ 7 ], and lesions have since been reported in patients of, e.g., Sudanese [ 5 ], Turkish [ 4 ], Guatemalan [ 15 ], African-American [ 8 ], Saudi-Arabian [ 9 ], Mexican [ 2 , 6 , 18 ], Central Amazonian Indian [ 10 ], American Caucasian [ 11 , 14 ] and Argentinian [ 35 ] origin. In some ethnic groups, the prevalence is quite low, from 0.11% of the general Caucasian population in Sweden [ 36 ] and 0.09% for the province of Jujuy in Argentina ( n = 2147) [ 35 ]; in contrast, it was reported to be 19.4% ( n = 460, 46% of the inhabitants) among the indigenous Greenlanders from Nanortalik in southwest Greenland [ 37 ] and 32.3% in children of the Mexican Nahuatl ethnic group ( n = 343) [ 2 ].…”

“…When it comes to clinical manifestations of FEH, in some instances, the characteristic nodules spontaneously disappear, leaving no residual functional or esthetic defects [ 5 , 6 ]. The duration of lesions was reported to last several weeks to more than 30 years [ 6 , 19 ], and many cases were reported to be asymptomatic, warranting no further treatment [ 2 , 5 , 6 , 8 , 9 , 10 , 11 , 12 , 13 , 14 ]. However, in order to prevent coinfection with high-risk HPV genotypes, a prophylactic HPV vaccination, which also includes some cross-protection against related genotypes, can be utilized [ 41 ].…”

“…The condition clinically presents as multiple 0.2–3 cm [ 2 ], whiteish to mucosal-colored, soft papular or nodular, elevated lesions in the oral cavity [ 3 , 4 , 5 , 6 ] ( Figure 1 a), which disappear when the mucosa is stretched [ 7 ]. While many cases have been reported to be asymptomatic [ 2 , 5 , 6 , 8 , 9 , 10 , 11 , 12 , 13 , 14 ], some lesions grow to a size or at a location where treatment is recommended [ 5 , 8 , 9 , 15 , 16 , 17 ]. A recent systematic review assessed the age of published cases from 1966–2020, and found a wide range of 3–92 years, with a higher reported rate in younger individuals (mean 23.1 years) and a male-to-female ratio of 3:4 [ 1 ].…”