Multifocal epithelial hyperplasia (Heck disease) in a 7-year-old boy

A 7-year-old boy from Angola presented at the dermatology department with a 2-year history of slowly enlarging, asymptomatic oral papules. The patient was otherwise healthy, and testing for immunodeficiency, including HIV, was negative. There were no similar lesions in other family members. Clinical examination showed numerous flat, white, coalescing papules and plaques on the lower labial mucosa. Otherwise, extraoral examination did not show any abnormalities. Histopathologic analysis from a representative lesion showed parakeratosis, acanthosis, marked epithelial hyperplasia and koilocytosis. The diagnosis of multifocal epithelial hyperplasia (or Heck disease) was supported by the presence of human papillomavirus (HPV) type 13 on polymerase chain reaction analysis. Treatment options for multifocal epithelial hyperplasia comprise surgical removal, laser excision, electrocautery, cryotherapy and topical agents such as imiquimod, retinoic acid or trichloroacetic acid.