Heck’s disease, formally known as Focal Epithelial Hyperplasia (FEH), is a rare, benign infectious condition affecting the mucous membranes inside the mouth. It presents as a proliferation of the oral lining that causes multiple small, raised lesions. The condition is harmless and typically does not cause pain or discomfort, often making it an incidental finding. Heck’s disease is most often observed in children and young adults, though it can appear at any age.
Viral Origins and Spread
The underlying cause of Heck’s disease is an infection by specific, low-risk types of the Human Papillomavirus (HPV). The primary culprits are HPV types 13 and 32, which are detected in the vast majority of diagnosed lesions. These viral types are distinct from the high-risk HPV strains associated with certain cancers, classifying Heck’s disease as a non-oncogenic condition.
Transmission of the virus occurs through direct contact, often involving close personal interaction or shared items. This mode of spread explains why the condition is frequently observed to cluster within families or small, close-knit communities. Overcrowded living environments and poor hygiene practices may facilitate the spread of the virus, particularly among children and adolescents.
While viral exposure is necessary, other factors contribute to the development of the symptomatic disease. A person’s immune status plays a significant role, with immunosuppressed individuals, such as those with HIV, showing a higher incidence of the condition. Furthermore, genetic predisposition is suspected to influence an individual’s susceptibility, as the disease is more prevalent in certain indigenous populations worldwide.
Identifying the Lesions
The clinical presentation of Heck’s disease involves a distinct appearance on the oral mucosa. The lesions are typically multiple, appearing as small, raised papules or nodules that are soft to the touch. They are generally between two and ten millimeters in diameter and may merge together to form larger patches.
These growths are often the same color as the surrounding healthy tissue, but they can also be slightly paler, pinkish, or white. A characteristic clinical feature is a smooth, rounded surface that sometimes resembles a “cobblestone” texture. The most common sites for these lesions include the inside of the cheeks (buccal mucosa), the inner surfaces of the lips (labial mucosa), and the tongue.
The lesions are overwhelmingly asymptomatic, meaning they do not cause pain. However, patients might notice a feeling of roughness or thickness in the affected area. In rare instances, the location or size of the lesion may lead to mild irritation, especially from accidental biting or during routine activities like eating and brushing teeth.
Treatment Approaches and Outcomes
Because Heck’s disease is benign and does not pose a serious health risk, a primary management strategy is often watchful waiting. In many cases, the lesions will spontaneously resolve on their own, disappearing within a few months to several years without medical intervention. This conservative approach is favored, especially for young patients or when the lesions are small and not causing functional issues.
Intervention becomes necessary when the lesions are bothersome, such as causing aesthetic concern, interfering with speech or chewing, or if they are frequently traumatized. Several treatment options exist when removal is warranted. These include surgical excision, cryotherapy (freezing the tissue), and laser ablation (using a carbon dioxide laser to vaporize the growth).
The prognosis for individuals with Heck’s disease is excellent. While removal procedures are generally effective, recurrence is possible, meaning new lesions may develop in the same or different oral locations. Topical medications, such as imiquimod cream, have shown promise by stimulating the immune system to fight the underlying viral infection, offering a non-invasive alternative.