|LETTER TO EDITOR
|Year : 2014 | Volume
| Issue : 2 | Page : 130-131
Blood-filled blister in the oral cavity: Angina bullosa hemorrhagica
Naveen Kumar Kansal
Department of Dermatology and Venereology, Gian Sagar Medical College and Hospital, Ram Nagar, Patiala, Punjab, India
|Date of Web Publication||11-Jun-2014|
Naveen Kumar Kansal
Department of Dermatology and Venereology, Gian Sagar Medical College and Hospital, Ram Nagar, Patiala, Punjab
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Kansal NK. Blood-filled blister in the oral cavity: Angina bullosa hemorrhagica. CHRISMED J Health Res 2014;1:130-1
Patients with oropharyngeal lesions/ulcers present to dermatologists, dental surgeons, otolaryngologists, and general physicians. Differential diagnosis of these lesions includes conditions like herpes, candidiasis, aphthosis, pemphigus, and lichen planus, etc. However, there are conditions which are relatively rare. Term 'angina bullosa hemorrhagica' (ABH) describes such condition in which essential clinical feature is acute, striking appearance of blood-filled vesicle/bulla in oral mucosa. Lesion lasts few hours to a day and ruptures spontaneously to form superficial erosion, which heals without any scarring. ABH is self-limited and requires no special treatment.
A 37-year-old male presented with complaint of asymptomatic hemorrhagic lesion in the oral mucosa, which he noticed in the morning during brushing his teeth. Directed questioning did not reveal any specific dietary intakes or any specific mouthwash use. His past history was negative for any bleeding diathesis. The patient was non-smoker, non-alcoholic, and non-tobacco chewer. On examination, a blood-filled vesicle of dark-red color and about half cm in size was noted on posterior aspect of left buccal mucosa [Figure 1]. Routine laboratory tests including complete blood count, platelet count, and coagulations tests were normal. On the basis of classic presentation, a clinical diagnosis of ABH was made and patient was asked to follow-up after 1 week. At follow-up visit, vesicle resolved without any sequela.
|Figure 1: Blood-fi lled vesicle on the posterior aspect of left buccal mucosa|
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ABH was first described by Badham in 1967 as blood-filled blisters in oral, pharyngeal mucosae.  The onset is acute and idiopathic (primary): No cause was identified in 47% of patients in large series of 30 patients.  Most common association with ABH is probably chronic use of inhalational corticosteroids in asthmatics. Other less common precipitating factors include minor trauma caused by eating food, especially crispy foods, dental procedures, chlorhexidine gluconate mouth rinse,  shouting, etc.
Kirtschig and Happle  considered the term ABH ('angina') to be misleading and coined a more appropriate term: 'Stomatopompholyx haemorrhagica.' However, some large blisters may cause a sensation of choking and Gibson justified the term 'angina.' Other designations used include localized oral purpura,  benign hemorrhagic bullous stomatitis and recurrent or traumatic oral hemophlyctenosis.
Clinically, the onset of the blister is sudden and painless; most of the lesions are located on soft palate and at junction of soft and hard palate. The color of intact lesion is bright red to purple and it may have an ecchymotic halo, which may support role of minor trauma as a provoking factor. ABH ruptures soon to leave an erosion/ulcer with ragged edges which heals in about 7-10 days. Relapses are known to occur.
The diagnosis of this clinical entity is essentially clinical, though lesions of ABH need to be carefully differentiated from subepithelial bullous diseases, lesions due to bleeding disorders, blood dyscrasias, angiomatoid lesions of Rendu-Osler-Weber disease and other systemic and dermatological disorders. , A classic presentation with prompt resolution should establish the diagnosis; however, biopsy for histopathology and DIF should be taken in doubtful cases. ,
No active treatment is needed. Symptomatically, benzydamine hydrochloride mouthwashes may be used; Chlorhexidine gluconate mouthwash should possibly be avoided as it was associated with ABH. 
| References|| |
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|2.||Badham NJ. Blood blisters and the oesophageal cast. J Laryngol Otol 1967;81:791-803. |
|3.||Stephenson P, Lamey PJ, Scully C, Prime SS. Angina bullosa haemorrhagica: Clinical and laboratory features of 30 patients. Oral Surg Oral Med Oral Pathol 1987;63:560-5. |
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|5.||Kirtschig G, Happle R. Stomatopompholyx hemorrhagica. J Am Acad Dermatol 1994;31:804-5. |