Abstract:

Heck disease – focal epithelial hyperplasia (FEH) is a rare chronic disease caused by human papilloma virus(HPV) that affects mainly oral, rarely genital and anal mucosa. It can be seen in various ethnic groups, especiallyin Eskimos, South Amerindians and South Africans. There are also Turkish cases in the literature.It presents with asympthomatic soft papules in the same color or whiter than mucosa ranging from 1 to 4mm. Histopathologically, acanthosis and coilocytosis are observed. The disease can show progressionas well as spontaneous regression. The treatment options, especially for local lesions, include excision,electrocauterization, cryotherapy and laser. Succesful results have also been reported with systemic treatmentssuch as retinoids, interferon- α2b and methotrexate in disseminated cases and also with topical interferon-β andimiquimod. However, recurrences may occur.A 39-year-old man attended to our clinic with a complaint of asymptomatic papules on his labial commissures.His medical history revealed that topical therapies prescribed for his warts did not work and recurrence occurredafter five sessions of electrocauterization. Dermatological examination revealed verrucous papules, with yellowcrusts in some, on bilateral labial commissures and widespread papules in the oral cavity in the same colorwith mucosa. Irregular acanthosis and coilocytosis were observed in the histopathological examination of oneof these lesions. According to the clinical and histopathological findings the patient was diagnosed with Heckdisease-FEH. Nd: YAG laser treatment is planned for the recalcitrant lesions that failed to respond to systemicacitretin treatment in combination with cryotherapy and electrocauterization.

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