Figure 1. These two photos are from a 13 year-old HIV negative male with multifocal epithelial hyperplasia. Note the smooth surface of these papules on the bucal and lip mucosas. The clinical appearance of these lesions is quite similar to that of condyloma acuminatum. The differential diagnosis is established by history, biopsy and if possible in situ hybridization to identify the responsible virus.
This viral disease was previously known as focal epithelial hyperplasia or Heckšs disease. The causative agent of multifocal epithelial hyperplasia (MEH) has been shown by means of immunohistochemical studies and in situ hybridization to be the human papiloma viruses (HPV) 13 and 32.
This disease is most prevalent in indigent populations of South and Central America, Africa as well as in the Esquimo population. The majority of affected patients are in the first and second decade of life. A familiar tendency also has been documented but it is attributed to the viral contagious nature as well as to similar life style, the same living conditions and malnutrition.
Clinically MEH is characterized by intraoral papular lesions which are generally present on the labial, bucal and tongue mucosa. These lesions mostly have a smooth surface with a color similar to that of normal oral mucosa. Occasionally some patients present wart-like eruptions similar to those seen in condyloma acuminatum. The palatal mucosa and the floor of the mouth are rarely affected. As a rule there is no symptomatology associated to MEH, occasionally and if large in size, there will be bleeding, mostly induced by accidental biting of the lesions.
Figure 2. Lip mucosa with multiple whitish, smooth-surfaced papules in an HIV positive male. A biopsy of one of these lesions showed the typical cell within-a-cell ("mitosoid" figures) phenomenon, characteristic of multiple epithelial hyperplasia.
Figure 3. Another example of multiple epithelial hyperplasia in an HIV positive male. Note the whitish, confluent, elevated papules on the border of the tongue. Also note the white striations on the lateral border of the tongue which represent an early stage of hairy leukoplakia.