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Introdução: a hiperplasia epitelial focal (HEF) ou doença de Heck, caracteriza-se por ser uma lesão benigna rara da mucosa bucal. Geralmente, está associada a proliferação do epitélio pavimentoso atribuída principalmente ao papiloma vírus humano (HPV) dos subtipos 13 e 32. Objetivo: relatar o caso de um paciente, com suspeita diagnóstica de HEF, descrever suas manifestações clínicas bucais e histopatológicas. Metodologia: homem, 38 anos, melanoderma, compareceu no Serviço Universitário com queixa de ardência em mucosa bucal. Ao exame clínico, apresentava múltiplas lesões papulares, firmes à palpação, de coloração rósea, com pápulas aglomeradas ou isoladas, localizadas em rebordo alveolares, gengiva inserida e livre da arcada superior e inferior, mucosas jugais e labiais, compatíveis com lesões causadas por HPV. Realizou-se biópsia incisional das lesões bucais, o laudo histopatológico descreveu o fragmento de mucosa bucal que estava revestida por epitélio pavimentoso estratificado paraceratinizado com acantose proeminente, projeções focais confluentes para o tecido conjuntivo, confirmando a suspeita diagnóstica clínica. Conclusão: a HEF é uma patologia rara, benigna da mucosa, indolor e que pode se resolver espontaneamente. Portanto, é necessário o diagnóstico adequado através da biopsia e laudo histopatológico.

Introduction: focal epithelial hyperplasia (FEH) or Heck's disease is characterized as a rare benign lesion of the oral mucosa. It is usually associated with proliferation of the squamous epithelium, mainly attributed to human papillomavirus (HPV) subtypes 13 and 32. Objective: to report the case of a patient with a diagnostic suspicion of HEF, to describe its oral clinical and histopathological manifestations. Methodology: hale, 38 years old, black, attended the University Service with a complaint of burning in the oral mucosa. On clinical examination, she presented multiple papular lesions, firm to palpation, pink in color, with agglomerated or isolated papules, located in the alveolar ridge, inserted gingiva free from the upper and lower arch, jugal and labial mucosa, compatible with lesions caused by HPV. An incisional biopsy of the oral lesions was performed, the histopathological report described the fragment of oral mucosa that was lined with parakeratinized stratified squamous epithelium with prominent acanthosis, focal projections confluent to the connective tissue, confirming the clinical diagnostic suspicion. Conclusion: FEH is a rare, benign mucosal pathology, painless and can resolve spontaneously. Therefore, proper diagnosis through biopsy and histopathological report is necessary.

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Resumen El Fibroma traumático es una alteración caracterizada por una producción exagerada de tejido conjuntivo fibroso, producida por traumas crónicos. Generalmente se encuentra en mucosa oral como carrillos o lengua. En este caso en particular debido a que la paciente tiene dentición en el maxilar inferior y edentulismo total superior, se puede apreciar como progresó la lesión en la mucosa labial. La paciente de ochenta años acudió por renovación de su prótesis total superior debido a que dejo de usarla porque estaba desadaptada. Al examen clínico se observa un agrandamiento a nivel de mucosa labial superior izquierda, no dolorosa a la palpación y de coloración ligeramente blanquecina. Se decide tomar una biopsia excisional para establecer el diagnóstico definitivo debido a que existen varias lesiones con presentación clínica similar, la lesión fue compatible con un fibroma traumático, este trabajo se presenta con el objetivo de presentar las características clínicas e histopatológicas de un fibroma traumático, enfatizando la importancia de un diagnóstico temprano y oportuno para efectuar un tratamiento eficaz. Es importante considerar que, si la intervención quirúrgica no se acompaña con la rehabilitación protésica oral, pudiera aparecer una recidiva de la lesión.

Resumo Fibroma Traumático é uma alteração caracterizada por uma produção exagerada de tecido conjuntivo fibroso, produzido por traumas crónicos. É geralmente encontrada na mucosa oral, como bochechas ou língua. Neste caso particular, devido ao fato do paciente ter dentição no maxilar inferior e edentulismo total no maxilar superior, pode-se ver como a lesão na mucosa labial progrediu. A paciente de 80 anos veio para a renovação da sua prótese total superior porque deixou de a usar por ser inapta. Ao exame, foi observado um aumento da mucosa do lábio superior esquerdo, que não era doloroso à palpação e tinha uma cor ligeiramente esbranquiçada. Foi decidido fazer uma biópsia excisional para estabelecer o diagnóstico definitivo, pois existem várias lesões com apresentação clínica semelhante, a lesão era compatível com um fibróide traumático, este trabalho é apresentado com o objetivo de apresentar as características clínicas e histopatológicas de um fibróide traumático, enfatizando a importância do diagnóstico precoce e oportuno para o tratamento eficaz. É importante considerar que se a intervenção cirúrgica não for acompanhada por uma reabilitação protética oral, teria surgido uma recidiva da lesão.

Abstract Traumatic Fibroma is a disorder characterized by an exaggerated production of fibrous connective tissue, produced by chronic trauma. It is usually found in oral mucosa such as cheeks or tongue. In this particular case, due to the fact that the patient has dentition in the lower jaw and total edentulism in the upper jaw, it can be seen how the lesion in the lip mucosa progressed. The eighty year old patient came for renewal of her upper total prosthesis because she stopped using it because she was unfit. On examination, an enlargement was observed at the level of the upper left lip mucosa, which was not painful on palpation and was slightly whitish in colour. It was decided to take an excisional biopsy to establish the definitive diagnosis because there are several lesions with similar clinical presentation, the lesion was compatible with a traumatic fibroid, this work is presented with the aim of presenting the clinical and histopathological characteristics of a traumatic fibroid, emphasizing the importance of early and timely diagnosis for effective treatment. It is important to consider that if the surgical intervention is not accompanied by oral prosthetic rehabilitation, a recurrence of the injury would have appeared.

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Human papillomavirus type 13 (HPV13) is a low-risk HPV type associated with Multifocal Epithelial Hyperplasia (MEH). It is considered a rare pathology of oral mucosa, more prevalent in certain ethnical groups, such as the Maya from Yucatan in Mexico. As for 2020 only two complete genomes of HPV13 are publicly available in Genbank database (one from Turkey one from the Amazonian). We aimed to obtain the complete genome sequence of HPV13 associated to MEH, obtained from a community in the Mayan area from Mexico. A bank of oral swabs from children with MEH were used. To enrich the sample, a Rolling Cycle Amplification (RCA) method was performed followed by overlapping end-point PCR of 500 bp fragments, Sanger sequencing and assembly. Eight open reading frames (ORFs) were annotated (E1, E2, E4, E5, E6, E7, L1 and L2 genes). When compared with the other two previously reported genomes the identity at nucleotide level is high 98.9% and 99.6%, respectively. The phylogenetic tree shows that Yucatan HPV13 is more closely related to HPV13 obtained from the Amazonian. Most changes identified at amino acid level are substitutions derived from nucleotide variations or SNPs in coding regions. Amino-acid changes were observed in E2 and E1 proteins (n ≥ 8), and in L1, L2, E6 and E5 proteins (n ≤ 5). E7 protein from Yucatan has 100% identity with the reported from Amazonian and differs (94.1% identity) with the one from Turkey due to 3 substitutions and three missing amino acids. In conclusion, the genome from HPV13 (7831 bp, 49 nt missing) associated to MEH in the Mayan area from Yucatan was obtained from stored swabs; this is the first effort in Mexico, the second in Latin America, and the third of the world. More research that contributes to the knowledge of the determinants underlying this neglected pathology are urged.

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The most important microscopic characteristic of Cyclosporine A-induced gingival overgrowth is fibroepithelial hyperplasia. OBJECTIVE: The objective was to investigate the influence of previous exposure to Cyclosporine A over gingival epithelium in experimental periodontitis in rats. METHODS: Twenty Wistar rats with 12 weeks-old were divided into four groups with 5 animals each: Control Group (CG); Cyclosporine Group (CsAG); Ligature group (LG) and Cyclosporine and Ligature Group (CsALG). Daily doses of CsA (10 mg/kg) were applied to CsAG and CsALG during 60 days since the beginning of the experiment and, a ligature was placed in LG and CsALG 30 days after the beginning of the experiment. After 60 days, animals were euthanized and gingival tissue was processed to histomorphometric analysis of epithelial thickness (mm2), immunohistochemical expression of PCNA (%) and inflammatory response. Data were analyzed by Kruskal-Wallis and Mann Whitney at 0.05 significance level. RESULTS: Considering epithelial thickness, CG was thinner than all groups, CsALG was the largest and CsAG and LG were similar between each other. Regarding the PCNA expression CG (16.46 ± 9.26) was similar to CsAG (34.47 ± 19.75) and, LG (59.02 ± 10.33) was similar to CsALG (40.59 ± 18.25). Significant difference (p < 0.05) occurred only in inflammation presence comparing CG/LG and CsAG/CsALG. A weak positive correlation between the number of PCNA+ and inflammatory cells (p = 0.001; r = 0.611) was observed. CONCLUSION: Based on these results it was concluded that the enlargement of gingival epithelium observed in experimental periodontitis can be increased by previous exposition to CsA and inflammatory conditions enhanced proliferative activity of the keratinocytes.

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La enfermedad de Heck o hiperplasia epitelial focal es una enfermedad que afecta la mucosa oral de niños y adolescentes principalmente, caracterizada por presentar pápulas que tienden a confluir y formar lesiones papilomatosas, cuyo origen está asociado al virus del papiloma humano. Se presenta en la comunidad Kukush-Yamanunca, parroquia Limoncocha, ciudad de Shushufindi, provincia de Sucumbíos en la Amazonia del Ecuador, el caso de un infante indígena, etnia Shuar, de 9 años de edad, quien acude al puesto de salud Yamanunca por presentar desde hace aproximadamente 10 meses de evolución lesiones papilomatosas en cavidad oral y lengua que corresponden clínicamente con hiperplasia epitelial focal. El conocimiento de las características clínicas y factores de riesgo son pilares importantes para el diagnóstico clínico de esta afección.

Heck's disease or focal epithelial hyperplasia is a disease that affects the oral mucosa of children and adolescents mainly, characterized by presenting papules that tend to converge and form papillomatous lesions, whose origin is associated with the humanpapillomavirus. It is presented in the Kukush-Yamanunca community, Limoncocha parish, Shushufindi city, Sucumbios province in the Amazon of Ecuador, the case of an indigenous infant, 9-year-old Shuar ethnicity, who comes to Yamanunca health post for presenting Approximately 10 months of evolution papillomatous lesions in oral cavity and tongue that correspond clinically with focal epithelial hyperplasia. The knowledge of the clinical characteristics and risk factors are important pillars for the clinical diagnosis of this condition

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Glyphosate-based herbicides (GBHs) are extensively used to control weeds on both cropland and non-cropland areas. No reports are available regarding the effects of GBHs exposure on uterine development. We evaluated if neonatal exposure to a GBH affects uterine morphology, proliferation and expression of proteins that regulate uterine organogenetic differentiation in rats. Female Wistar pups received saline solution (control, C) or a commercial formulation of glyphosate (GBH, 2mg/kg) by sc injection every 48h from postnatal day (PND) 1 to PND7. Rats were sacrificed on PND8 (neonatal period) and PND21 (prepubertal period) to evaluate acute and short-term effects, respectively. The uterine morphology was evaluated in hematoxylin and eosin stained sections. The epithelial and stromal immunophenotypes were established by assessing the expression of luminal epithelial protein (cytokeratin 8; CK8), basal epithelial proteins (p63 and pan cytokeratin CK1, 5, 10 and 14); and vimentin by immunohistochemistry (IHC). To investigate changes on proteins that regulate uterine organogenetic differentiation we evaluated the expression of estrogen receptor alpha (ERα), progesterone receptor (PR), Hoxa10 and Wnt7a by IHC. The GBH-exposed uteri showed morphological changes, characterized by an increase in the incidence of luminal epithelial hyperplasia (LEH) and an increase in the stromal and myometrial thickness. The epithelial cells showed a positive immunostaining for CK8, while the stromal cells for vimentin. GBH treatment increased cell proliferation in the luminal and stromal compartment on PND8, without changes on PND21. GBH treatment also altered the expression of proteins involved in uterine organogenetic differentiation. PR and Hoxa10 were deregulated both immediately and two weeks after the exposure. ERα was induced in the stromal compartment on PND8, and was downregulated in the luminal epithelial cells of gyphosate-exposed animals on PND21. GBH treatment also increased the expression of Wnt7a in the stromal and glandular epithelial cells on PND21. Neonatal exposure to GBH disrupts the postnatal uterine development at the neonatal and prepubertal period. All these changes may alter the functional differentiation of the uterus, affecting the female fertility and/or promoting the development of neoplasias.

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La hiperplasia epitelial focal o enfermedad de Heck es una enfermedad poco frecuente de la mucosa bucal. Afecta principalmente a niños, sin distinguir sexo o grupo étnico. Clínicamente se caracteriza por la presencia de pápulas blancas o de igual coloración que la mucosa oral, de pequeño tamaño, asintomáticas y con tendencia a confluir y formar lesiones papilomatosas. Esta enfermedad se ha asociado con infección por virus del papiloma humano y a factores genéticos. Se presenta el caso de una paciente de ocho años, que acudió a consulta de Dermatología en el Hospital Andino de Chimborazo, por lesiones en mucosa bucal con correspondencia clínica e histopatológica con la enfermedad de Heck.

Epithelial Focal Hyperplasia or Heck disease is an infrequent disease of the oral mucosa. It mainly affects children, without distinguishing sex or ethnic group. It is clinically characterized by the presence of white papules or of similar colour of the oral mucosa, small size, asymptomatic and with the tendency to converge and form papillomatous lesions. This disease has been associated with infection by human papilloma virus and genetic factors. A case of an eight year old girl is presented, who came to the Dermatology consultation at Andino Hospital Chimborazo Ecuador, with lesions in the oral mucosa with clinical and histopathological correspondence with Heck disease.

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Propósito: El propósito del estudio fue evaluar la efectividad de la terapia con el ácido tricloroacético en el tratamiento de las lesiones orales producidas en la hiperplasia epitelial focal. Material y métodos: Se incluyeron 11 pacientes que presentaron características clínicas e histopatológicas de hiperplasia epitelial focal y que aceptaron participar en el estudio, se aplicó muestreo por conveniencia, en pacientes que asistieron a consulta de la clínica odontológica de la Corporación Universitaria Rafael Núñez y la Universidad de Cartagena, se les realizó biopsia excisional en una de las lesiones para establecer diagnóstico anatomopatológico, posteriormente se aplicó ácido tricloroacético al 80% sobre las lesiones cada quince días hasta que desaparecieron. Resultados: De un total de 11 pacientes pediátricos el 63.64% fueron de género femenino, promedio de edad fue nueve años, los sitios de mayor afección en cavidad bucal fueron mucosa labial superior e inferior representando un 100%, en el estudio anatomopatológico se describió la presencia de acantosis epitelial, papilomatosis y coilocitosis en todos los casos, el mayor número de aplicaciones con el ácido fue tres y cuatro veces con un 27%, el promedio de desaparición de las lesiones fue de 61.3 días, no se ha presentado recidiva en el 100% de los casos. Conclusión: La aplicación del ácido tricloroacético en la hiperplasia epitelial focal es una técnica efectiva, consiguiendo la resolución de las lesiones en forma rápida, poco traumática, sin generar ansiedad y temor en los pacientes.

Objective: The aim of the present study was to assess effectiveness of trichloroacetic acid therapy in the treatment of oral lesions produced in focal epithelial hyperplasia cases. Material and methods: In the present study 11 patients were included. Patients exhibited clinical and histopathological characteristics of focal hyperplasia and were willing to participate in the study. Convenience sampling was executed in patients attending clinical consultation at the Dental Clinic of the Rafael Nuñez University Corporation and the University of Cartagena. Patients underwent excision biopsy in one of the lesions so as to establish anatomical-pathological diagnosis. Subsequently, 80% trichloroacetic acid was applied every two weeks on the lesions, until lesions disappeared. Results: Out of 11 pediatric patients 63.64% were female, average age nine years. Locations of greater involvement in the mouth were upper and lower labial mucosa (representing 100%). Anatomical-pathological study revealed in all cases presence of epithelial acanthosis, papillomatosis and koilocytiosis. The greatest number of acid applications was three and four episodes with 27%, average time for lesion disappearance was 61.3 days. No relapse was observed in 100% of cases. Conclusion: Trichloroacetic acid application in focal epithelial hyperplasia cases is an effective technique which achieves rapid, atraumatic stress-free lesion resolution which did not generate fear in involved patients.

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Focal epithelial hyperplasia (FEH), or Heck's disease, is a rare disease of the oral mucosa associated with infection by some subtypes of human papilloma virus, especially subtypes 13 or 32. The disease is predominantly found in children and adolescents with indigenous heritage, but other ethnic groups can be affected worldwide. To the best of the authors' knowledge, it has not been reported in Brazil's elderly population. This article describes a case of FEH in a 57-year-old Brazilian patient presenting since childhood, with multiple lesions in the lips, buccal mucosa and tongue. The solitary tongue lesion underwent excisional biopsy and the histopathological analysis showed parakeratosis, acanthosis, rete pegs with a club-shaped appearance, koilocytosis and the presence of mitosoid cells. These microscopic findings in conjunction with clinical presentation were sufficient to establish the accurate diagnosis of FEH. Polymerase chain reaction (PCR) was performed, but no one human papillomavirus (HPV) subtype could be identified. Clinicians must be aware of this rare oral disease, which can even affect elderly patients, as we described here. Treatment may be indicated in selected cases due to esthetic and/or functional problems.

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La hiperplasia epitelial multifocal es una enfermedad benigna que se caracteriza por la presencia de múltiples pápulas en la mucosa de la cavidad bucal, asociada con el virus del papiloma humano 13 y 32. En el presente trabajo se describen tres casos con características clínicas similares, donde se evidencian múltiples pápulas no dolorosas localizadas en mucosa bucal y lengua, mostrando un curso lento y benigno las cuales no habían sido diagnosticadas previamente por dentistas de práctica general. Se llevó a cabo el diagnóstico basado en las características clínicas patognomónicas de las lesiones, historia familiar y evolución; se les dio información a los pacientes acerca de su padecimiento y se mantienen periódicamente en observación. El objetivo de este trabajo es mostrar las características clínicas de la hiperplasia epitelial multifocal y hacer una revisión de la literatura en cuanto a la etiología de las lesiones su evolución, diagnóstico diferencial y tratamiento.

Multifocal epithelial hyperplasia is a benign disease characterized by the presence of multiple papules in oral cavity mucosa. It is as-sociated with HPV 13 and 32. In this paper, we describe three cases with similar clinical features, involving the presence of multiple painless papules localized in the oral mucosa and on the tongue, and displaying a slow and benign course. The condition had not been previously diagnosed by general dental practitioners. We made our diagnosis based on the pathognomonic clinical features of the lesions, family history, and evolution of the condition. The patients concerned were provided with information about their disease and kept under regular observation. The aim of this article is to describe the clinical features of multifocal epithelial hyperplasia and present a review of the literature on the etiology of the lesions, their evolution, differential diagnosis, and treatment.

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La hiperplasia epitelial focal, conocida también como enfermedad de Heck, es relativamente rara; ocurre en niños y adolescentes. Se presenta el caso de una paciente de 20 años que fue atendida en al Hospital Universitario Manuel Ascunce Domenech, de Camagüey, por presentar lesiones papulares de diez meses de evolución. Se descartaron otras enfermedades virales, pero se concluyó por estudios histológicos que se trataba de la enfermdedad de Heck, la cual es conocida entre los odontólogos, pero poco por pediatras, internistas y dermatólogos. Por su etiología, muchos casos tienen relación con la infección por el virus del papiloma humano. El tratamiento, cuando la enfermedad progresa, puede realizarse con excisión, tratarse con láser o crioterapia. En esta paciente se empleó el último procedimiento, con buenos resultados pues se encuentra totalmente asintomática.

Focal epithelial hyperplasia, also known as Heck’s disease, is relatively rare, occurring mostly in children and adolescents. A case of a 20 year-old female patient treated at the Manuel Ascunce Domenech University Hospital in Camagüey due to papular lesions, which had evolved for ten months, is presented. Other viral diseases were ruled out; however based on histological studies, it was concluded that she suffered from Heck disease, which is frequently treated by dentists, but little known among pediatricians, internists and dermatologists. Because of its etiology, many cases are related to human papilloma virus infection. When the disease evolves, treatment can involve excision, laser surgery or cryotherapy. The latter method was used in this patient with satisfactory results, as she is completely asymptomatic.

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Focal Epithelial Hyperplasia (FEH) or Heck’s disease is a rare and benign condition characterized by cell proliferation in the squamous epithelium, which is manifested clinically as verrucous projections. It is associated with Human Papillomavirus (HPV) subtype 13 or 32, and it is often observed in children, young adults, and middle aged individuals, as well as some ethnic groups such as Indians and Eskimos, which suggests a possible hereditary influence. Objective: knowing that FEH is a rare disease among the Brazilian population, this article reports a case of FEH in a Brazilian family. Case report: a 27 year-old woman was assisted in the Department of Dentistry of the Federal University of Rio Grande do Norte (UFRN) showing round, plane, and well-defined lesions localized in the oral cavity, with an evolution of six years. Lesions underwent incisional biopsy, and the microscopic analysis revealed epithelial changes such as epithelium hyperplasia and prominent acanthosis. These histopathologic findings were consistent with the clinical hypothesis of FEH. Final considerations: this report reinforces the need for an accurate clinical assessment, so dentists are able to recognize, diagnose, and treat FEH in their own patients.

A hiperplasia epitelial focal (HEF) ou doença de Heck é uma doença benigna, rara e caracterizada por proliferação celular no epitélio escamoso, que se manifesta clinicamente como projeções verrucosas. É associada com o papilomavírus (HPV), subtipo humano 13 ou 32, e, muitas vezes, é observada em crianças, adultos jovens e pessoas de meia-idade, bem como em alguns grupos étnicos, como os índios e esquimós, o que sugere uma possível influência hereditária. Objetivo: sabendo que a HEF é uma doença rara na população brasileira, este artigo relata um caso de HEF em uma família brasileira. Relato de caso: paciente feminina, de 27 anos de idade, foi atendida no Departamento de Odontologia da Universidade Federal do Rio Grande do Norte (UFRN), mostrando lesões bem definidas, arredondadas, planas, localizadas em cavidade oral e com uma evolução de seis anos. As lesões foram submetidas a biópsia incisional, e a análise microscópica revelou alterações epiteliais, como hiperplasia do epitélio e acantose proeminente. Esses resultados histopatológicos foram consistentes com a hipótese clínica de HEF. Considerações finais: este relatório reforça a necessidade de uma avaliação precisa da clínica, para dentistas serem capazes de reconhecer, diagnosticar e tratar HEF em seus próprios pacientes.

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La hiperplasia epitelial focal, conocida también como enfermedad de Heck, es una patología benigna que se caracteriza por la presencia de múltiples pápulas en la mucosa de la cavidad bucal; es producida por los subtipos 13 y 32 del virus del papiloma humano, aunque también se le relaciona con factores genéticos, inmunosupresión e higiene bucal deficiente pero con poco sustento científico; afecta principalmente a niños y adolescentes. Se reporta caso clínico de paciente femenina de 7 años de edad, remitida al servicio de Estomatología y Cirugía Oral de la Corporación Universitaria Rafael Núñez por presentar múltiples pápulas en mucosa bucal, de tamaño variable, asintomáticas, 8 meses de evolución, relacionadas clínicas e histológicamente con hiperplasia epitelial focal.

Focal epithelial hyperplasia also known as Heck's disease is a benign disease characterized by the presence of multiple papules on the mucosa of the oral cavity is produced by 13 and 32 subtype of human papilloma virus, also related to genetics factors, immunosup-pression and poor oral hygiene with little scientific support and primarily affects children and adolescents. A case report of a 7-year-old female patient is presented who was referred to the service of Dentistry and Oral Surgery at Rafael Núñez University for presented several papules in the oral mucosa, variable in size, asymptomatic with 8 months of development, related clinical and histological with focal epithelial hyperplasia.

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La Enfermedad de Heck (EH) o Hiperplasia Epitelial Focal (HEF) es una proliferación benigna poco frecuente de la mucosa oral, generalmente asintomática, causada por el Virus Papiloma Humano (VPH), en su mayoría VPH 13 y 32. Afecta principalmente a niños, predominantemente de sexo femenino. En general se resuelve en forma espontánea, pero en algunos casos por su sintomatología o extenso compromiso se requiere de tratamiento. Existen múltiples modalidades terapéuticas, destacando entre ellas el Imiquimod. Describimos el caso de una paciente de ocho años de edad con una EH que presentó buena respuesta al tratamiento con Imiquimod 5 por ciento.

Heck’s Disease (HD) or Focal Epithelial Hyperplasia (FEH) is a rare benign proliferation of the oral mucosa, usually asymptomatic, caused by Human Papilloma Virus (HPV), especially HPV 13 and 32. Affects mainly children, predominantly female.FEH generally resolves spontaneously, but some cases, either because of intensity or extension of symptoms may require treatment. There are several therapeutic alternatives, being Imiquimod the most successful. We report the case of a 8-year old with a HD that present good response to treatment with Imiquimod 5 percent.

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La hiperplasia epitelial focal conocida también como enfermedad de Heck es una patología benignaque se caracteriza por la presencia de múltiples pápulas en la mucosa de la cavidad bucal, producidapor el virus del papiloma humano afectando principalmente niños y adolescentes. Se reportacaso clínico de paciente femenina de 7 años de edad, remitida por odontopediatría al servicio deestomatología y cirugía oral, por presentar múltiples pápulas en mucosa bucal, de tamaño variable,asintomáticas y de 8 meses de evolución, se realizó biopsia excisional en una de las lesiones yel estudio anatomopatológico reportó hiperplasia epitelial sin atipias; como terapéutica se aplicóácido tricloroacético al 80%, observándose resolución de las lesiones con seis topicaciones.

Focal Epithelial Hyperplasia also known as Heck's disease is a benign pathology characterized bythe presence of multiple papules in the mucosa of the oral cavity, produced by the human papillomavirus affecting mainly children and adolescents. A clinical case of a 7 year old female patient wasreported who was referred by Pediatric Dentistry to the Stomatology and Oral surgery Service dueto the presence of multiple papules in the oral mucosa which were variable in size, asymptomatic and had a history of 8 months; an excisional biopsy was performed in one of the lesions and theanatomic pathological study reported epithelial hyperplasia without atypia. Trichloroacetic acid at 80%was applied as treatment and resolution of the lesions was observed with six topical applications.

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La Hiperplasia Epitelial Focal es una patología que se caracteriza por la presencia de múltiples pápulas en la mucosa de la cavidad oral, producida por subtipos del papiloma virus humano 13 y 32, normalmente se presenta en niños y adolescentes, las lesiones se encuentran con mayor frecuencia en las mucosas labial, yugal y Iingual. Entre las diferentes alternativas de tratamiento se encuentra la quirúrgica, criocirugía, vitamina A, ablación con laser. El ácido tricloroacético es utilizado en el tratamiento de infecciones con virus del papiloma humano como condiloma, papiloma, verrugas vulgares en la mucosa vaginal arrojando buenos resultados presentándose resolución de las lesiones y mucosa vaginal en buen estado. Se reportan dos casos de pacientes femeninas pediátricas, remitida al servicio de estomatología y cirugía bucal de la universidad de Cartagena para el manejo y diagnóstico de múltiples lesiones en mucosa bucal. Se establece diagnóstico de hiperplasia epitelial focal y se decide implementar terapéutica con la aplicación de acido tricloroacético al 95%, observándose resolución de las lesiones con dos aplicaciones tópicas

Focal epithelial hyperplasia is a condition that is characterized by the presence of several papules on the oral cavity mucous membrane, It`s of viral etiology caused by human papilloma virus subtypes 13 and 32, usually occurs in children and adolescents rarely affects adults, injuries are more frequently found in the labial mucosa, buccal and Iingual. Among the various treatment alternatives include surgery, cryosurgery, vitamin A, laser ablation. Trichloroacetic acid is used in the treatment of infections with human papilloma virus as condyloma, papilloma, warts in the vaginal mucosa showing good results, successful resolution of the lesions and vaginal mucosa and in good condition. We report two cases of female patient, referred to the department of stomatologic and oral Surgery of Cartagena University for further management and diagnosis of multiple lesions in the oral mucosa. Diagnosis of focal epithelial hyperplasia is established and decided to implement therapeutic application of trichloroacetic acid 95%, observing resolution of lesions with two topical applications

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