Multifocal epithelial hyperplasia: Clinical features, diagnosis and management challenges.

Area of Science:

• Oral pathology
• Virology
• Dermatology

Background:

• Multifocal epithelial hyperplasia (MEH), or Heck's disease, is a benign oral mucosa condition.
• It is strongly associated with low-risk human papillomavirus (HPV) genotypes 13 and 32.
• MEH predominantly affects children and adolescents from Indigenous American countries.

Purpose of the Study:

• To review current knowledge on MEH epidemiology, viral mechanisms, clinical and histopathological features.
• To summarize diagnostic strategies, including molecular and immunohistochemical methods.
• To discuss therapeutic approaches and identify knowledge gaps for MEH.

Main Methods:

• Narrative review of recent findings on MEH.
• Synthesis of information on epidemiology, viral mechanisms, clinical presentation, and histopathology.
• Evaluation of diagnostic tools (PCR, in situ hybridization, immunohistochemistry) and therapeutic options.

Main Results:

• MEH presents as asymptomatic papules/nodules with a cobblestone appearance.
• Histopathology shows epithelial hyperplasia, koilocytosis, and altered cytokeratin expression.
• Molecular and immunohistochemical methods aid in diagnosis and differential diagnosis.

Conclusions:

• MEH is typically self-limiting but may require treatment in specific cases.
• There is a need for improved diagnostic access, targeted vaccines, and public health strategies for MEH.
• Further research is needed on host-virus interactions and standardized treatment protocols for MEH.