Makindo Medical Notes

Angina Bullosa Haemorrhagica (ABH)

Angina Bullosa Haemorrhagica (ABH) is a benign condition characterized by the sudden appearance of blood-filled blisters in the oral cavity, most commonly on the soft palate of middle-aged and elderly individuals. These blisters rupture spontaneously and heal without scarring.

About

• ABH is not associated with systemic diseases or blood dyscrasias; however, it is essential to exclude these conditions during evaluation.

Aetiology

• Mechanical trauma from dental procedures, sharp foods, or accidental biting.
• Use of inhaled steroids or chlorhexidine mouth rinses.
• Underlying systemic conditions like diabetes mellitus may contribute.
• Fragility of the oral mucosal blood vessels in older adults.

Clinical Features

• Sudden onset of painless, blood-filled blisters in the oral cavity, especially on the soft palate, tongue, or buccal mucosa.
• Blisters are fragile and rupture easily, leading to superficial erosions.
• Patients may experience a sensation of fullness or discomfort before blister rupture.
• Lesions heal spontaneously within 7–10 days without scarring.

Differential Diagnoses

• Autoimmune blistering diseases:
  • Pemphigus vulgaris
  • Mucous membrane pemphigoid
  • Bullous lichen planus
• Blood dyscrasias (e.g., thrombocytopenia)
• Vascular malformations
• Hereditary hemorrhagic telangiectasia

Investigations

• Full blood count (FBC) to assess for anemia or thrombocytopenia.
• Coagulation profile to exclude clotting disorders.
• Blood glucose levels to check for diabetes mellitus.
• Serological tests for autoimmune diseases if indicated.
• Biopsy is generally not required but may be performed if diagnosis is uncertain.

Management

• Provide reassurance to the patient about the benign nature of the condition.
• Advise avoidance of trauma to the oral mucosa (e.g., careful brushing, avoiding sharp foods).
• Symptomatic relief with mouthwashes:
  • Benzydamine hydrochloride mouthwash for pain relief.
  • Chlorhexidine mouthwash to prevent secondary infection.
• Review and modify use of potential causative agents (e.g., inhaled steroids) if appropriate.
• Regular follow-up if lesions are recurrent or persistent.

Conclusion

ABH is a self-limiting condition with an excellent prognosis. Proper identification and patient education are key to management, ensuring unnecessary interventions are avoided.