This image shows widespread asymptomatic, soft, raised papules over the oral mucosa and lips of a 9 year old girl (fig 1). The papules had been present from early childhood and became more prominent when she consumed citrus and spicy stimulants. Her mother reported a history of similar lesions during her childhood, which had regressed over time.bmj;383/dec07_5/e077602/F1F1f1Fig 1Focal epithelial hyperplasia, also known as Heck’s disease, is a rare oral condition caused by human papillomavirus. It more commonly affects female adolescents, with studies suggesting that environmental influences and a genetic predisposition play a role.1 The diagnosis was confirmed by an incisional biopsy sample, which showed squamous mucosa lined by hyperplastic squamous epithelium displaying regional parakeratosis, acanthosis, and vacuolisation of epithelial cells. The cells were positive for human papillomavirus using in situ hybridisation. Heck’s disease is self-limiting and patients can be counselled on the benign nature of the lesions.2 Excision for aesthetic…
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