Angina bullosa haemorrhagica
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.
