Heck's disease

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Heck's disease
Other names: Multifocal epithelial hyperplasia, focal epithelial hyperplasia[1]
SymptomsSmall bumps in mouth[1]
TypesPapulonodular, papillomatous[1]
Diagnostic methodAppearance, biopsy[1]
TreatmentNone, cryosurgery, carbon-dioxide laser, electrosurgery and IFN[2]
FrequencyRare, females>males[1]

Heck's disease is a harmless skin condition of the mucosa, which presents as soft small bumps or slightly larger ones in the mouth, characteristically appearing like 'cobblestone', generally in children.[1] They are the same color as the surrounding skin and typically occur in multiple numbers on the tongue and inner lower lip.[1] Quality of life may be affected by its appearance, or by difficulties in chewing.[1] Adults with the condition tend to have fewer bumps.[1]

It is caused by the human papilloma virus types 13 and 32.[2] There is possibly a genetic association.[1] Some cases have been reported in people with lepromatous leprosy, rheumatoid arthritis, leukocyte adhesion deficiency and immunosuppressive diseases.[1] Diagnosis is by appearance and biopsy.[1] It exhibits surface cells with vacuolated cytoplasm around irregular, pyknotic nuclei and occasional cells with mitosis-like changes within otherwise mature and well-differentiated epithelium. A distinguishing histologic feature is elongated rete ridges with mitosoid bodies.[3]

It generally resolves without treatment.[1] Treatment options include cryosurgery, carbon-dioxide laser, electrosurgery and IFN.[2]

The condition is rare, but is five times more common in females than males, and occurs most frequently in indigenous peoples of the Americas, eskimos of Greenland, Inuits and descendants of South African Khoisan; sometimes present in up to a third of some of these populations.[2] It was first reported in the Eskimo population of North America.[1]

Immediate postoperative aspect a) and surgical specimen b).


  1. 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 Sethi, Sneha; Ali, Anna; Ju, Xiangqun; Antonsson, Annika; Logan, Richard; Jamieson, Lisa (27 January 2021). "An update on Heck's disease—a systematic review". Journal of Public Health: fdaa256. doi:10.1093/pubmed/fdaa256. ISSN 1741-3842. Archived from the original on 9 July 2022. Retrieved 22 June 2022.
  2. 2.0 2.1 2.2 2.3 James, William D.; Elston, Dirk; Treat, James R.; Rosenbach, Misha A.; Neuhaus, Isaac (2020). "19. Viral diseases". Andrews' Diseases of the Skin: Clinical Dermatology (13th ed.). Edinburgh: Elsevier. p. 411. ISBN 978-0-323-54753-6. Archived from the original on 2022-07-09. Retrieved 2022-06-23.
  3. Archard, Howell O; Heck, John W; Stanley, Harold R (1965). "Focal epithelial hyperplasia: An unusual oral mucosal lesion found in Indian children". Oral Surgery, Oral Medicine, Oral Pathology. 20 (2): 201–12. doi:10.1016/0030-4220(65)90192-1. PMID 14322615.