Focal Epithelial Hyperplasia in a Somali Child: A Case Report and Review of Management with Topical Imiquimod.
Mohamed A Hersi, Mohamud M Abdulkadir, Mohamed Abdulkadir Hassan-Kadle et al.
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Case in brief
An 8-year-old Somali girl had a 3.5-year history of asymptomatic, progressively increasing oral lesions. Examination showed multiple soft, flat-topped verrucous papules on the lower labial, buccal and lingual mucosa and gingiva; focal epithelial hyperplasia (Heck’s disease) was diagnosed clinically. Off-label topical imiquimod 5% cream was applied three times weekly. Local erythema, erosion, crusting and minor bleeding, with burning, mild pain and transient feeding difficulty, prompted a one-week treatment break and supportive care. After treatment resumed, the lesions resolved completely within ten weeks of total management, with no recurrence during 16 months of follow-up.
What made this case unusual
The report documents focal epithelial hyperplasia in a Somali child, a setting in which the condition is described as underreported. Imiquimod treatment was complicated by local mucosal reactions that required a temporary treatment holiday.
Diagnostic / clinical pearl
Multiple soft, flat-topped verrucous papules across oral mucosal sites in a child can support a clinical diagnosis of focal epithelial hyperplasia.
Why it matters
The case adds a documented presentation from Somalia and illustrates that local reactions during topical imiquimod therapy may require a temporary pause and supportive care.