eNewsletter Dermatology Sign Up
Look good, feel great with Beautiful Skin
Crutchfield Dermatology Home Patient Reviews Patient Portal Make a Payment Leading Doctors Best Doctors in America Consumer’s Research Council of America Top Dermatologist for Women Mpls St. Paul Top Doctors Crutchfield Dermatology Awarded 2008 Best of St. Paul for their Excellence in Skin Care Mpls St. Paul Top Doctors Physcian Health Care Heros America's Top Doctors Request Appointment eNewsletter Sign Up
Medical Education Sectiongif

25 year old woman presents with an 4 year evolving history of papules expanding to cover her inner cheeks, bilaterally. She complains of intermittent mild discomfort only. She is otherwise healthy, HIV-negative, and taking only OCP’s.

What is your diagnosis?

heck image

Diagnosis: Heck's disease (also known as focal epithelial hyperplasia)

Heck’s disease is an uncommon condition characterized by white or flesh-colored papules that occur diffusely in the oral cavity. It is caused by the human papilloma virus types 13 and 32. In this particular case she had type 32. Type 13 is seen in younger children. The first case was described in 1965 in Native Americans. The majority of recent cases have been described in Native Central and South American populations.

The viral infection is very contagious and can be endemic among children in close areas- sometimes as many as 30% of the children in a community can be affected. Adults seem to have minimal evidence of residual oral lesions and so the lesions are presumed to eventually disappear on their own over time.

Risk factors for this condition include poor hygiene, low socioeconomic status, immunosuppression and living in close proximity to others. Extensive lesions have been reported in HIV-positive patients.

It 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 imiquimod5% cream daily to a small area on her inner cheek. 30 days in to treatment she reports noticeable improvement and wishes to continue.


For additional information please see:





Focal Epithelial Hyperplasia



Case of the Month

Cases of the Month Archives

gif gif

Crutchfield Dermatology

651-209-3600       Look Good, Feel Great with Beautiful Skin ™

Prestigious Organizations
MetroDoctors ASDS-Net.org ASCDAS.org NMANET.org aestheticmd.com Better Business Bureua
expert injectorMayo Clinic American Board Dermatology American Medical Med.UMN.edu cosmeticsurgery.org ASNA Top Dermatologist

AAD Fellow Alpha Omega Alpha
© Crutchfield Dermatology All Photographs are © copyright protected. Unauthorized use is prohibited 651-209-3600

Crutchfield Dermatology
1185 Town Centre Drive Suite 101 Eagan, MN 55123
Call for appointment: 651-209-3600 Fax: 651-209-3601

top 100 places to work

Proudly serving: The greater Twin Cities area, Minneapolis, St. Paul, Edina, Eden Prairie, Eagan, Richfield, Bloomington, Hopkins, Savage, Mendota Heights, St. Louis Park, Wayzata, Plymouth, Maple Grove, Crystal, Roseville, West St. Paul, Apple Valley, Burnsville

Web Design Arbor Bay Marketing


Alpha Omega Alpha Honor Medical Society