Issue link: https://viewer.e-digitaledition.com/i/307452
Case of the Month with Crutchfield Dermatology A 25-YEAR- OLD WOMAN PRESENTS with a four-year evolving history of papules expanding to cover her inner cheeks, bilaterally. She complains of intermit- tent, mild discomfort only. She is otherwise healthy, HIV-negative and taking only oral contraceptive pills. What is your diagnosis? Diagnosis: Heck's Disease Heck's disease, also known as focal epithelial hyperplasia, is an uncommon condition characterized by white or flesh-colored papules that occur diffusely in the oral cavity. It is caused by human papillomavirus Types 13 and 32. This patient had type 32. Type 13 is seen in younger children. The first case was described in 1965 and occurred among Native Americans. The majority of recent cases have been among native Central and South American populations. The viral infection is very contagious and can be endemic among children in close proximity to each other — sometimes as many as 30 percent of the children in a community can be affected. Adults seem to have minimal evidence of residual oral lesions, so the lesions are presumed to eventually disappear on their own over time. Risk factors for this condition include poor hygiene, low socioeco- nomic status, immunosuppression and living in close proximity to others. Extensive lesions have been reported in HIV-positive patients. The condition is most commonly seen in children and young adults. Treatment is only symptomatic, and the lesions eventually disappear. Because this patient was mildly symptomatic, I had her try imiquimod 5 percent cream daily on a small area on her inner cheek. Thirty days into treatment, she reports noticeable improvement and wishes to continue. For more information, contact Charles E. Crutchfield III, MD, at Crutchfield Dermatology or visit www.CrutchfieldDermatology.com. ■ +++++++++++++++++++ +++ + +++ + +++++++++++++++++++ DIAGNOSTICS High Pointe Health Campus Off I94 and Radio Drive 651.439.8807 or 800.423.1088 www.stcroixortho.com U R G E N T C A R E Radio Drive Radio Drive Radio Drive H ud s on B l v d High Pointe 7 DAYS A WEEK Orthopaedic Urgent Care Providing walk-in care for: • F ractures • D islocations • Sp rains and Strains • Mus cle Pain • Joi nt Pain • Sp orts Injuries • C oncussions Monday - Friday 1:00 p.m. to 8:00 p.m. Saturday & Sunday 8:00 a.m. to noon • No appointment is necessary • All patients are seen by a physician • Patients have direct access to specialty orthopaedic care