Focal Epithelial Hyperplasia Prevalence in an Endemic Population, Molecular Association of HPV-13 to Asymptomatic Patients and Comparison Between Three Elementary Schools of Different Income Levels

Abstract

Heck’s disease, or Focal Epithelial Hyperplasia (FEH), caused by Human Papilloma Virus (HPV) subtypes 13 and mainly 32, is a rare and benign pathology of the oral mucosa; diagnosis is confirmed by PCR analysis. This is a common disease in the Mayan and other Native-American populations, most frequently between 2-13 years. Risk factors include lower income class, poor hygiene and genetic predisposition. This cross-sectional study aims to determine the prevalence of clinically compatible lesions of FEH in children from low, middle and high-income in 3 elementary schools in Yucatan, Mexico. Clinical evaluation was conducted and documented for later analysis by a dermatologist familiar with FEH. Samples were taken and HPV-13 was identified by PCR. The total of 186 subjects were analyzed from the low-income elementary school, with 41 subjects presenting FEH lesions and 76 presented HPV-13 upon PCR analysis. In the middle-income school, of the 144 subjects studied, 3 had FEH lesions and 8 presented HPV-13 upon PCR analysis. In the high-income elementary school, 96 students were studied, and none presented FEH lesions, however, 6 had HPV-13 positivity. FEH and HPV-13 prevalence were inversely proportional to socioeconomic status. Lacking an association to a particular gender or difference in the age groups studied.