Focal epithelial hyperplasia – an update

Abstract

Focal epithelial hyperplasia (FEH) is an asymptomatic benign mucosal disease, which is mostly observed in specific groups in certain geographical regions. FEH is usually a disease of childhood and adolescence and is generally associated with people who live in poverty and of low socioeconomic status. Clinically, FEH is typically characterized by multiple, painless, soft, sessile papules, plaques or nodules, which may coalesce to give rise to larger lesions. Human papillomavirus (HPV), especially genotypes 13 and 32, have been associated and detected in the majority of FEH lesions. The clinical examination and social history often allow diagnosis, but histopathological examination of lesional tissue is usually required to confirm the exact diagnosis. FEH sometimes resolves spontaneously however, treatment is often indicated as a consequence of aesthetic effects or any interference with occlusion. There remains no specific therapy for FEH, although surgical removal, laser excision or possibly topical antiviral agents may be of benefit. There remains no evidence that FEH is potentially malignant.

Multiple Oral Mucosal Hamartomas in a 34-Year Old Female

“…As a result, dentists and oral health practitioners could potentially become a first line of discovery against this affliction. Heck's disease or FEH is a rare, benign proliferation of mucosal surfaces caused primarily by the HPV subtypes 13 and 32 [5]. It typically presents as multifocal, verrucous papules of the labial, lingual, and buccal mucosa which often lacks a relevant family history [6].…”

“…Nodules from FEH are pink and non-inflammatory with no notable symptoms other than their bulk which could theoretically hinder the motion of the various oral structures. However, FEH is unlikely in adults over 18 years of age and is strongly associated in patients of Native American or Latino descent, suggesting a genetic predisposition [5,7]. Some literature reports have linked the expression of the HLA-DR4 leukocyte antigen as a culprit, noting the possible inability of the HLA-DR4 histocompatibility complex molecules to properly bind to certain HPV-13 or 32 viral proteins [6].…”

“…Regardless of this connection, the nodules of FEH are most often self-limited with an average lifespan of 18 months. Our patient's ethnicity, age, and the years-long presence of her nodules make a diagnosis of FEH implausible [5][6][7].…”

“…Microscopy revealed a pebbly papulonodular lesion displaying surface stratified squamous epithelium accompanied by hyperparakeratosis, papillomatosis, acanthosis with elongated broad and slender rete processes, and mild suprapapillary epithelial atrophy (Figs. 4,5,6). Physiologic pigmentation (melanin pigment) was seen in the cytoplasm of the basal keratinocytes.…”

Molecular biology for hpv typing in focal epithelial hyperplasia

“…Detection of specific HPV genotype by polymerase chain reaction (PCR) is a specific and sensitive method to confirm the diagnosis of FEH (2). Susceptible HPV subtypes of condyloma acuminatum and oral squamous cell papilloma are most frequently 6,11,16 and 18 (3).…”