What are the other Names for this Condition? (Also known as/Synonyms)

• ABH (Angina Bullosa Hemorrhagica)
• Angina Bullosa Haemorrhagica (ABH)

What is Angina Bullosa Hemorrhagica? (Definition/Background Information)

• Angina Bullosa Hemorrhagica (ABH) is a benign oral cavity condition of unknown cause that is characterized by the formation of blood-filled vesicles (blisters), usually on the soft palate. The condition is generally self-resolving following rupture of the lesion
• The condition is not associated with any known hematological (blood) and mucocutaneous (mucosal and skin surface) disorders, or any systemic conditions. Trauma is a known precipitating factor for Angina Bullosa Hemorrhagica, and ABH is termed an oral mucosal traumatic lesion
• There are no significant signs and symptoms associated with this oral cavity lesion. Also, in many individuals, Angina Bullosa Hemorrhagica is a self-limited condition that regresses following rupture of the lesion

Who gets Angina Bullosa Hemorrhagica? (Age and Sex Distribution)

• Angina Bullosa Hemorrhagica (ABH) may be observed in children and adults
• Both males and females are affected
• There is no racial or ethnic preference observed
• However, ABH is a rare lesion of the mouth

What are the Risk Factors for Angina Bullosa Hemorrhagica? (Predisposing Factors)

The risk factors for Angina Bullosa Hemorrhagica may include:

• Chronic use of steroids, either topical agents or nasal sprays
• Dermatitis herpetiformis
• Epidermolysis bullosa
• Genetic susceptibility
• Lichen planus
• Linear IgA disease
• Oral amyloidosis
• Pemphigoids
• Poorly-controlled diabetes
• Trauma to the region is the most commonly identified risk factor

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Angina Bullosa Hemorrhagica? (Etiology)

• The exact cause of formation of Angina Bullosa Hemorrhagica is not well-understood
• These mouth lesions are not associated with any systemic blood or mucosal conditions

What are the Signs and Symptoms of Angina Bullosa Hemorrhagica?

The signs and symptoms of Angina Bullosa Hemorrhagica may include:

• Presence of a solitary blood-filled large blister (vesicle) in the mouth
• The size of the blister may range from 1 to 3 cm
• The most common site is the soft palate; other locations include the buccal mucosa (inside of the cheeks) and tongue
• Rarely, more than a single vesicle may be seen on the mucosal surfaces
• The blister typically breaks and heals presenting a thin ulcer-like lesion
• Pain and discomfort is not associated with the lesion, even after it ruptures
• No scarring is noted at the site of the lesion post-rupture and healing

How is Angina Bullosa Hemorrhagica Diagnosed?

A diagnosis of Angina Bullosa Hemorrhagica may involve the following exams and procedures:

• Physical examination (including oral examination) of the individual and medical history evaluation
• Dermoscopy: Dermoscopy is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
• Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
• Skin biopsy: A skin biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis
• If an autoimmune skin disease is considered possible, blood tests or an immuno-biopsy may be undertaken

A differential diagnosis is important to exclude other conditions presenting similar signs and symptoms. These include:

• Bullous lichen planus
• Bullous pemphigoid
• Dermatitis herpetiformis
• Epidermolysis bullosa
• Oral amyloidosis
• Pemphigus
• Thrombocytopenia

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Angina Bullosa Hemorrhagica?

The possible complications due to Angina Bullosa Hemorrhagica may include:

• Emotional stress
• Difficulty in eating and chewing may be present
• Superimposed bacterial and fungal infections are not generally noted

How is Angina Bullosa Hemorrhagica Treated?

• In a majority of cases, no treatment is necessary for Angina Bullosa Hemorrhagica since it resolves spontaneously after rupture of the blister
• Benzydamine hydrochloride may be used for symptomatic treatment, if needed, by the healthcare provider. Also, good oral hygiene may be advised including mouth rinses

How can Angina Bullosa Hemorrhagica be Prevented?

Currently, there are no available measure to prevent Angina Bullosa Hemorrhagica since the cause of the condition is unknown.

What is the Prognosis of Angina Bullosa Hemorrhagica? (Outcomes/Resolutions)

• The prognosis of Angina Bullosa Hemorrhagica is generally excellent
• The condition is self-limited and known to heal following rupture of the blood-filled blister usually within a week

Additional and Relevant Useful Information for Angina Bullosa Hemorrhagica:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/healthy-living/dental-health/