A CLINICO- EPIDEMIOLOGICAL, GENETIC AND MOLECULAR ANALYSIS OF FOCAL EPITHELIAL HYPERPLASIA (FEH)

Abstract

Objectives FEH is a benign mucosal condition often presenting in female children. The Indian descendants in America, Eskimos in Greenland and Canada, the Nahuatl population in Mexico and Aboriginals in Australia are commonly affected populations while in Africa; cases have been reported from the Khoi San population in South Africa and from Ghana and Nigeria. Clinically, lesions may be localised or multiple, flat (Papillomatous) or raised (Papillonodular) and are more common on the lips and buccal mucosa Material and Methods An epidemiological demographic screening project between 2015-2017 was undertaken for FEH by the NRU, Khartoum, Sudan. This assessed 647 persons in the age groups 5–38 years living in the province of ‘Kalakla’ (North, West and East), an area with a high population of FEH presentation as determined by health statistical analysis, ministry of health. Clinical assessment was carried out in all persons and genetical and molecular HPV subtyping was carried out in 30% of the assessed population. Findings 77% of persons were 5-15 years, 14% were between 16-27 and 9% were between 28-38 of age. Of 647 persons, 147 persons were clinically diagnosed with FEH and the lips were the commonest area affected. Mean age of presentation was 14 years (range: 5 – 23), 27% of persons with FEH had a familial relation and 132/147 were female. 30/147 underwent PCR analysis and HPV 32 was the most common subtype, followed by 1,11,12 and 13. 3 persons had no evidence of HPV infectivity. Finally, 12/15 persons who underwent genetical analysis were positive for HLA DRB 1*0404 expression. Conclusion Persons with FEH and their relatives are greatly affected by the aesthetic, medical and traumatic concerns related with this condition. Differential diagnosis includes other viral lesions, epidermodysplasia verruciformis, dysplastic PUVA keratosis and syndromes such as Neurofibromatosis and Cowdens.