Makindo Medical Notes

Angina Bullosa Haemorrhagica (ABH)

🩸 Angina Bullosa Haemorrhagica (ABH) is a benign oral mucosal condition with sudden onset of blood-filled blisters, most often on the soft palate of middle-aged and elderly patients. The blisters rupture spontaneously and heal without scarring.

📖 About

• Not linked to systemic disease or blood dyscrasias ➝ but always exclude underlying haematological or autoimmune disorders in assessment.
• Usually self-limiting and underdiagnosed in general practice.

🧬 Aetiology

• Mechanical trauma (dental procedures, sharp foods, accidental biting).
• Medication-related ➝ inhaled corticosteroids, chlorhexidine mouth rinses.
• Systemic risk factors ➝ diabetes mellitus, hypertension.
• Age-related fragility of mucosal blood vessels.

🩺 Clinical Features

• Sudden appearance of painless, blood-filled blisters in the oral cavity (soft palate > tongue > buccal mucosa).
• Blisters are fragile, rupture within hours ➝ leaving superficial erosions.
• Some patients feel localised tension or discomfort pre-rupture.
• Heal within 7–10 days ✔️ no scarring.

🔍 Differential Diagnoses

• Autoimmune blistering diseases (usually recurrent & persistent):
  • Pemphigus vulgaris 🧪 (Nikolsky’s sign, biopsy + DIF positive).
  • Mucous membrane pemphigoid.
  • Bullous lichen planus.
• Blood dyscrasias ➝ thrombocytopenia, leukaemia.
• Vascular malformations, hereditary haemorrhagic telangiectasia.

🧪 Investigations

• FBC ➝ exclude anaemia, thrombocytopenia.
• Coagulation profile ➝ screen for clotting disorders.
• Blood glucose ➝ rule out diabetes.
• Autoimmune serology (if atypical or recurrent).
• Biopsy rarely required (only if uncertain or suspicion of autoimmune disease).

💊 Management

• ✅ Reassure ➝ benign, self-limiting condition.
• Prevent trauma ➝ gentle brushing, avoid sharp foods, review inhaler technique.
• Symptomatic relief:
  • Benzydamine hydrochloride mouthwash for analgesia.
  • Chlorhexidine mouthwash to reduce secondary infection risk.
• Modify contributing medications (e.g. steroid inhalers ➝ use spacer, rinse mouth after use).
• Review if recurrent ➝ rule out systemic associations.

💡 Teaching Pearls

• ABH = sudden solitary oral blood blister in elderly ➝ heals in a week.
• Key OSCE tip: Differentiate from pemphigus vulgaris (persistent, painful erosions + positive biopsy).
• Always exclude haematological disease if multiple/recurrent lesions.
• Remember: benign, but diagnosis is clinical and reassurance is the main “treatment”.

📚 References

• Field EA, et al. Angina bullosa haemorrhagica – clinical features and management. Oral Surg Oral Med Oral Pathol. 1997.
• BNF & NICE guidance on oral lesions.