Focal Epithelial Hyperplasia in Adult Patients With HIV Infection: Clearance With Topical Imiquimod.

Case 1 A 41-year-old man with human immunodeficiency virus (HIV) 1 diagnosed 16 years prior to his consultation was referred for an 8-month history of multiple painless lumps in his mouth. He had A2 status (CD4 cell count of 273 cells/mm3 and viral load of 43,000 copies/L) and was taking treatment with lamivudine/zidovudine (combivir) and efavirenz. Physical examination showed multiple small mucosal-colored and lobulated papulonodules located in the palate and lower gingiva and a whitish verrucous plaque on the lower labial mucosa (Figure 1a). The lesions were diagnosed clinically as focal epithelial hyperplasia (FEH) and further confirmed by classical histopathological findings (Figure 1b). He had previously received unspecified treatment; thus, topical 5% imiquimod cream was initiated every night. Mild erosion and ulceration developed in the upper labial mucosa, which were managed with lubrication (petrolatum ointment). After 2 weeks, all of the small lesions disappeared and the largest plaque resolved 1 week later (Figure 1c). A small residual mass in the area of biopsy, suggesting a scar, remained on the lower lip. The area was removed surgically and corresponded to fibrosis histologically, with no evidence of human papillomavirus (HPV) infection. CD4 cell count (694 cells/mm3) and viral load (<40 copies/L) did not show remarkable changes after imiquimod administration. No serious side effects were observed and the patient has remained free of disease after 1 year of follow-up.

Case Report of Focal Epithelial Hyperplasia (Heck's Disease) with Polymerase Chain Reaction Detection of Human Papillomavirus 13.

Focal epithelial hyperplasia (FEH), or Heck's disease, is an uncommon benign proliferation of oral mucosa caused by the human papillomavirus (HPV), particularly subtypes 13 and 32. The disease typically presents in young Native American patients and is characterized by multiple asymptomatic papules and nodules on the oral mucosa, lips, tongue, and gingiva. The factors that determine susceptibility to FEH are unknown, but the ethnic and geographic distribution of FEH suggests that genetic predisposition, particularly having the human lymphocytic antigen DR4 type, may be involved in pathogenesis. We report a case of FEH with polymerase chain reaction detection of HPV13 in a healthy 11-year-old Hispanic girl and discuss the current understanding of disease pathogenesis, susceptibility, and treatment.

Hiperplasia epitelial focal / Focal epithelial hyperplasia

La hiperplasia epitelial focal (HEF) o enfermedad de Heck es una patolog¡a poco frecuente de la mucosa oral, caracterizada por una proliferaci¢n benigna del epitelio debida a la infecci¢n por el papilomavirus humano (PVH) tipos 13 y 32. El nombre enfermedad de Heck deriva del nombre del m‚dico que evalu¢ al primer paciente, en M‚xico, en 1961. Sin embargo, una revisi¢n de la literatura latinoamericana revela publicaciones previas realizadas por Estrada, en 1956, quien observ¢ esta entidad en indios colombianos. Algunos a¤os despu‚s, Soneira y Fonseca realizaron la primera descripci¢n completa de la enfermedad, y se¤alaron sus caracter¡sticas cl¡nicas e histol¢gicas y, adem s, sugirieron el posible origen viral. Finalmente, en 1965, Archard y col. la denominaron HEF, aunque en la actualidad se sugiere utilizar el nombre de hiperplasia multifocal del epitelio, que describe mejor las caracter¡sticas cl¡nicas y microsc¢picas de la enfermedad. La HEF, aunque.

The focal epithelial hyperplasia (HEF) or Heck's disease is a rare disease of the oral mucosa, characterized by benign epithelial proliferation due to infection with human papillomavirus (HPV) ttypes 13 and 32. The disease name derives Heck the name of the doctor who evaluated the first patient in Mexico in 1961. However, a review of Latin American literature reveals previous publications by Estrada, in 1956, who observed this entity in Colombian Indians. Some years later, Soneira and Fonseca made the first complete description of the disease, noting their clinical and histological features and also suggested the possible viral origin. Finally in 1965, Archard et al. HEF called it, although at present it is suggested to use the name multifocal epithelial hyperplasia, which best describes the clinical and microscopic features of the disease. The HEF is presented with a clear predominance of Americans, Eskimos and Indians some communities in South Africa, although isolated cases in other ethnic groups. In South America it is more common in the Amazon basin of Peru, Venezuela, Colombia, Bolivia, Brazil and Paraguay.

Hiperplasia epitelial multifocal: reporte de tres casos clínicos y revisión de la literatura / Multifocal epithelial hyperplasia: a report of three clinical cases and review of the literature

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.

Displasia epitelial focal por el uso de un único cepillo dental en la familia / Focal epithelial dysplasia caused by the use of a sole family toothbrush

La hiperplasia epitelial focal es una de las patologías pertenecientes al grupo de infecciones causadas por el Virus del Papiloma Humano (VPH) relacionada con los tipos 13 y 32. Su transmisión es por contacto directo o indirecto con secreciones infectadas, siendo su grupo poblacional predilecto los niños, cuyo riesgo es mayor si presentan en su familia condiciones de salubridad insuficiente y malas prácticas de higiene. El tratamiento depende de la evolución de las lesiones que en la mayoría de los casos se resuelven espontáneamente, por lo que es suficiente con la observación. En caso de manifestaciones más severas se puede utilizar crioterapia, cirugía y acido acético (AU)

Focal epithelial dysplasia is one of the pathologies belonging to the group of infections caused by the Human Papilloma Virus (HPV), related to types 13 and 32. It is transmitted by direct or indirect contact with infected secretions, with its preferred population group being children, whose risk is greater if inadequate health conditions and bad hygiene practices are present in the family. Treatment is dependent on the evolution of lesions, which in the majority of cases remit spontaneously, in which case, observation is sufficient. In more severe cases, cryotherapy, surgery and acetic acid can be used (AU)

Mutation of Gtf2ird1 from the Williams-Beuren syndrome critical region results in facial dysplasia, motor dysfunction, and altered vocalisations.

Insufficiency of the transcriptional regulator GTF2IRD1 has become a strong potential explanation for some of the major characteristic features of the neurodevelopmental disorder Williams-Beuren syndrome (WBS). Genotype/phenotype correlations in humans indicate that the hemizygous loss of the GTF2IRD1 gene and an adjacent paralogue, GTF2I, play crucial roles in the neurocognitive and craniofacial aspects of the disease. In order to explore this genetic relationship in greater detail, we have generated a targeted Gtf2ird1 mutation in mice that blocks normal GTF2IRD1 protein production. Detailed analyses of homozygous null Gtf2ird1 mice have revealed a series of phenotypes that share some intriguing parallels with WBS. These include reduced body weight, a facial deformity resulting from localised epidermal hyperplasia, a motor coordination deficit, alterations in exploratory activity and, in response to specific stress-inducing stimuli; a novel audible vocalisation and increased serum corticosterone. Analysis of Gtf2ird1 expression patterns in the brain using a knock-in LacZ reporter and c-fos activity mapping illustrates the regions where these neurological abnormalities may originate. These data provide new mechanistic insight into the clinical genetic findings in WBS patients and indicate that insufficiency of GTF2IRD1 protein contributes to abnormalities of facial development, motor function and specific behavioural disorders that accompany this disease.

HPV-associated oral warts.

Human papillomavirus (HPV) is strictly epitheliotropic, infecting stratified squamous cutaneous and mucosal epithelial cells. Oral HPV infection may be subclinical or putatively associated with benign or malignant oral neoplasms. The benign HPV-associated oral lesions, focal epithelial hyperplasia (Heck disease), oral squamous cell papilloma, oral verruca vulgaris (common wart) and oral condyloma acuminatum, are collectively referred to as oral warts. Oral warts are usually asymptomatic, may be persistent or uncommonly, may regress spontaneously. HPV-associated oral warts have a prevalence of 0.5% in the general population, occur in up to 5% of HIV-seropositive subjects, and in up to 23% of HIV-seropositive subjects on highly active antiretroviral therapy. This paper is a clinico-pathological review of HPV-associated oral warts.

Hiperplasia epitelial focal / Focal epithelial hyperplasia

La hiperplasia epitelial focal (HEF) es una rara enfermedad de la mucosa oral producida por el virus papiloma humano (HPV) tipos 13 y 32, que presenta características clínicas e histológicas bien definidas. Predomina en indios americanos y esquimales, manifestándose generalmente en las dos primeras décadas de la vida. Presentamos una paciente argentina de 34 años de edad con lesiones orales clínica e histológicamente compatibles con HEF. El estudio por reacción en cadena de la polimerasa (PCR) detectó ADN del HPV tipo 13...

Focal epithelial hyperplasia (FEH) is a rare oral mucosa disease caused byhuman papillomavirus (HPV) types 13 and 32. It has well defined clinical andhistological characteristics. It is more prevalent in Native Americans and Eskimos,and most cases are diagnosed during the first two decades of life. Wepresent the case of a 34 years-old woman from Argentina with lesions in theoral mucosa that were clinically and histologically consistent with FEH. Analysisby polymerase chain reaction (PCR) detected HPV type 13 DNA...

TPA induction leads to a Th17-like response in transgenic K14/VEGF mice: a novel in vivo screening model of psoriasis.

Psoriasis is a common chronic inflammatory skin disease, characterized by epidermal hyperplasia, immune cell infiltration, increased dermal angiogenesis and local up-regulation of a variety of inflammatory mediators. Psoriasis is thought to be driven primarily by CD4(+) T cells with a T(h)1 and/or T(h)17 phenotype. Transgenic keratin 14 (K14)/vascular endothelial growth factor (VEGF) mice have previously been reported to develop a psoriasis-like phenotype. The aim of this study was to further characterize the model for validation as an in vivo screening model of psoriasis. Inflammation was induced in the ear skin with five topical applications of 12-O-tetradecanoyl phorbol-13-acetate (TPA) and a significantly increased inflammation was found in TPA-induced K14/VEGF transgenic animals compared with wild-type mice. The amount of VEGF in the ear tissue was significantly elevated resulting in increased dermal angiogenesis. Furthermore, intense epidermal hyperplasia, CD3(+) infiltration and significantly increased amounts of (TNF) tumor necrosis factor alpha, IL-1 beta, IL-6, IL-12/23p40, IL-12p70, IL-22 and IL-17 were detected in the inflamed ear skin. This cytokine profile strongly suggests a T(h)17-mediated inflammation. All findings were a result of induced over-expression of VEGF. Topical treatment with betamethasone-17-valerate (BMS) significantly reduced ear skin inflammation and epidermal hyperplasia and also decreased the CD3(+) infiltration. In conclusion, the TPA-induced phenotype in K14/VEGF animals displayed several features of psoriasis, including a T(h)17 cytokine profile and a chronic-like progression, and can be used as an in vivo screening model of psoriasis.

[Changes in oral mucosa of the partially edentulous who wear removable partial dentures ]. / Modification des muqueuses des cretes edentees dues au port de la prothese adjointe partielle en resine.

PURPOSE: to confirm or infirm structural modification of oral mycosis at the summit after fifteen days of wearing removable resin partial dentures. METHODS: our study took place at the health center of Rufisque in Senegal from January to July 1998, involved fourteen patients divided into two groups according to sex: seven males and seven females who came for removable resin partial dentures. The macroscopic examination was conducted through to inspection and touching of mycosis at the level of toothless summit before the wearing of the denture. A biopsy was conducted on each patient before and after the wearing of the resin dentures. Tissue reaction was appreciated qualitatively through morphological analysis. RESULTS: Before the wearing of the removable resin partial dentures 92.9% of patients had epithelial hyperplasia; 7.1% epithelial hypoplasia and 85.7% keratosis at the level of the chorion the number of collagen fibbers (28.6% discrete, 50% moderate, 21.4% important), fibroblasts (35.7% discrete; 42.9% moderate ; 21.4% important), inflammatory cells (71.4% discrete; 28.6% moderate; 0% important) and for blood vessels (64% discrete; 35.70% moderate; 0% important) after fifteen days of wearing partial denture. After fifteen days of the wearing removable resin partial dentures: 85.7% of patients had epithelial hyperplasia; 14.3% normal epithelial and 100% de keratosis at the level of the chorion the number of collagen fibbers (14.3% discrete; 21.4% moderate; 64.3% important), fibroblasts (42.9% discrete; 42.90% moderate; 14.3% important), inflammatory cells (50% discrete, 35.7% moderate: 14.3% important), blood vessels (43% discrete; 28.6% moderate; 28.6% important). CONCLUSION: Biopsies of the summit are reliable contribution; they provide precise information on the quality of tissue supporting resin partial dentures. This tissues may seem healthy appearance (inspection and touching) but show sign of suffering at this anatomy-pathological examination.

Recurrent focal epithelial hyperplasia due to HPV13 in an HIV-positive patient.

There are few reports on focal epithelial hyperplasia (FEH) in association with human immunodeficiency virus (HIV) infection; thus the relationship between them has not been completely clarified yet. We present a case of recurrent FEH in an HIV-positive man (the first described in Belgium), which, according to the PCR-DNA testing, was due to human papilloma virus type 13 (HPV13). To our knowledge, based on the accessible literature, this type of HPV has not been detected in any other documented study of FEH in HIV-positive patients before. Our patient experienced three recurrences of FEH in 1 year. It is therefore suggested that immunodeficiency due to HIV infection is responsible for the HPV-related FEH and the subsequent recurrences. In order to support the consideration of FEH as an oral manifestation of an HIV-related opportunistic infection, every new 'HPV-type' oral lesion in HIV-positive patients must be completely documented.

Sporadic cases of Heck disease in two Polish girls: association with human papillomavirus type 13.

Two sporadic cases of Heck disease in Polish girls were associated with human papillomavirus 13. No other children and nobody from their surroundings had similar lesions. The course of the disease was chronic in both patients. The lesions regressed spontaneously in one girl within several years after some of the papules were excised. The second girl's warts persist after eight years.

[Focal epithelial hyperplasia. An unusual clinical aspect]. / Hyperplasie épithéliale focale. Aspect clinique inhabituel.

We report a case of focal epithelial hyperplasia in a child born in France of Algerian parents. The clinical appearance was unusual in that certain lesions were verrucous and pediculate. A virological study revealed the presence of papillomavirus 32, one of the two types of HPV specifically associated with this entity.