Angina Bullosa Hemorrhagica Clinical Presentation

  • Author: Roman Carlos, DDS; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Apr 29, 2010
 

History

  • The blisters of angina bullosa hemorrhagica predominantly affect middle-aged or elderly people without sex predilection.
  • Some patients with angina bullosa hemorrhagica describe a stinging pain or burning sensation immediately before the appearance of the blood blister.
  • The blisters last only few minutes and then spontaneously rupture, leaving a shallow ulcer that heals without scarring, discomfort, or pain. Note the images below. A 42-year-old man with the sudden appearance of anA 42-year-old man with the sudden appearance of angina bullosa hemorrhagica. The patient experienced pain a few minutes before the bulla appeared. He had a history of 3 similar previous episodes at the same site. Because the lesions only stay intact for a short duration, the patient took the picture using his own cellular phone. A 42-year-old man with the sudden appearance of anA 42-year-old man with the sudden appearance of angina bullosa hemorrhagica. The patient experienced pain a few minutes before the bulla appeared. He had a history of 3 similar previous episodes at the same site. Because the lesions only stay intact for a short duration, the patient took the picture using his own cellular phone. Image shows 24 hours after the initial presentation of angina bullosa hemorrhagica.
  • Patients do not report a tendency to bleed at other sites.
  • Family history generally is noncontributory to angina bullosa hemorrhagica. Grinspan et al[2] reported that 44% of his patients in a series of 24 cases published in 1999 suffered from type II diabetes, hyperglycemia, or family history of diabetes. No conclusive evidence of a cause-and-effect relationship between the presence of angina bullosa hemorrhagica and glucose metabolism exists.
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Physical

  • The lesions of angina bullosa hemorrhagica reach an average size of 1-3 cm in diameter.
  • The soft palate is the most commonly affected site in angina bullosa hemorrhagica.[3]
  • Occasional lesions have been reported in the buccal mucosa and tongue.
  • The anterior third is most commonly affected in the tongue.
  • Approximately one third of the patients exhibit lesions in more than one location.
  • The oral mucosa attached to bone (ie, masticatory mucosa represented by the hard palate and gingiva) is not affected.
  • Similar lesions in other mucous membranes or the skin have not been reported.
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Causes

  • Slightly more than 50% of the cases described are related to the minor trauma of hot foods,[4] restorative dentistry,[5] or periodontal therapy.[6]
  • Other potential causes of angina bullosa hemorrhagica that have been mentioned in the literature are dental injections of anesthetics,[4, 7] steroid inhalers,[8, 7] and chlorhexidine gluconate mouthrinse.
  • A report of 16 cases affecting the soft palate described hypertension as the most frequent underlying systemic condition (6 of 16 subjects); however, its relationship remains speculative, as hypertension is common in adults.[9]
  • A causative factor is not identified in approximately 47% of patients with angina bullosa hemorrhagica.
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Contributor Information and Disclosures
Author

Roman Carlos, DDS  Staff Member, Department of Pathology, Hospital Herrera-Llerandi, Guatemala; Co-Director, Professor, Oral and Maxillofacial Pathology, Centro de Medicina Oral de Guatemala; Past President, International Association of Oral Pathologists; Chairman, Oral and Maxillofacial Pathology, Centro Clínico de Cabeza y Cuello, Guatemala; Diplomate, American Board of Oral and Maxillofacial Pathology

Roman Carlos, DDS is a member of the following medical societies: American Academy of Oral and Maxillofacial Pathology and International Association of Oral Pathologists

Disclosure: Nothing to disclose.

Specialty Editor Board

Terry L Barrett, MD  Clinical Professor of Dermatology and Pathology, University of Texas Southwestern School of Medicine; Director, ProPath Dermatopathology, Dallas, Texas

Terry L Barrett, MD is a member of the following medical societies: American Academy of Dermatology, American Dermatological Association, American Medical Association, American Society of Dermatopathology, College of American Pathologists, and United States and Canadian Academy of Pathology

Disclosure: Nothing to disclose.

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Drore Eisen, MD, DDS  Consulting Staff, Department of Dermatology, Dermatology Research Associates of Cincinnati

Drore Eisen, MD, DDS is a member of the following medical societies: American Academy of Dermatology, American Academy of Oral Medicine, and American Dental Association

Disclosure: Nothing to disclose.

Glen H Crawford, MD  Assistant Clinical Professor, Department of Dermatology, University of Pennsylvania School of Medicine; Chief, Division of Dermatology, The Pennsylvania Hospital

Glen H Crawford, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Phi Beta Kappa, and Society of USAF Flight Surgeons

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Department of Dermatology, Geisinger Medical Center

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

  1. Pahl C, Yarrow S, Steventon N, Saeed NR, Dyar O. Angina bullosa haemorrhagica presenting as acute upper airway obstruction. Br J Anaesth. Feb 2004;92(2):283-6. [Medline].

  2. Grinspan D, Abulafia J, Lanfranchi H. Angina bullosa hemorrhagica. Int J Dermatol. Jul 1999;38(7):525-8. [Medline].

  3. Yamamoto K, Fujimoto M, Inoue M, Maeda M, Yamakawa N, Kirita T. Angina bullosa hemorrhagica of the soft palate: report of 11 cases and literature review. J Oral Maxillofac Surg. Sep 2006;64(9):1433-6. [Medline].

  4. Garlick JA, Calderon S. Oral blood blisters in angina bullosa haemorrhagica secondary to trauma of eating and dental injection. Br Dent J. Oct 22 1988;165(8):286-7. [Medline].

  5. Corson MA, Sloan P. Angina bullosa haemorrhagica: an unusual complication following crown preparation. Br Dent J. Jan 6 1996;180(1):24-5. [Medline].

  6. Curran AE, Rives RW. Angina bullosa hemorrhagica: an unusual problem following periodontal therapy. J Periodontol. Nov 2000;71(11):1770-3. [Medline].

  7. de las Heras ME, Moreno R, Núñez M, Gómez MI, Ledo A. Angina bullosa hemorrhagica. J Dermatol. Jul 1996;23(7):507-9. [Medline].

  8. Higgins EM, du Vivier AW. Angina bullosa haemorrhagica--a possible relation to steroid inhalers. Clin Exp Dermatol. Jul 1991;16(4):244-6. [Medline].

  9. Horie N, Kawano R, Inaba J, et al. Angina bullosa hemorrhagica of the soft palate: a clinical study of 16 cases. J Oral Sci. Mar 2008;50(1):33-6. [Medline].

  10. Curran AE, Rives RW. Angina bullosa hemorrhagica: an unusual problem following periodontal therapy. J Periodontol. Nov 2000;71(11):1770-3. [Medline].

  11. Stephenson P, Scully C, Prime SS, Daly HM. Angina bullosa haemorrhagica: lesional immunostaining and haematological findings. Br J Oral Maxillofac Surg. Dec 1987;25(6):488-91. [Medline].

  12. Deblauwe BM, van der Waal I. Blood blisters of the oral mucosa (angina bullosa haemorrhagica). J Am Acad Dermatol. Aug 1994;31(2 Pt 2):341-4. [Medline].

  13. Edwards S, Wilkinson JD, Wojnarowska F. Angina bullosa haemorrhagica--a report of three cases and review of the literature. Clin Exp Dermatol. Nov 1990;15(6):422-4. [Medline].

  14. Giuliani M, Favia GF, Lajolo C, Miani CM. Angina bullosa haemorrhagica: presentation of eight new cases and a review of the literature. Oral Dis. Jan 2002;8(1):54-8. [Medline].

  15. Hopkins R, Walker DM. Oral blood blisters: angina bullosa haemorrhagica. Br J Oral Maxillofac Surg. Feb 1985;23(1):9-16. [Medline].

  16. Stephenson P, Lamey PJ, Scully C, Prime SS. Angina bullosa haemorrhagica: clinical and laboratory features in 30 patients. Oral Surg Oral Med Oral Pathol. May 1987;63(5):560-5. [Medline].

 
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A 42-year-old man with the sudden appearance of angina bullosa hemorrhagica. The patient experienced pain a few minutes before the bulla appeared. He had a history of 3 similar previous episodes at the same site. Because the lesions only stay intact for a short duration, the patient took the picture using his own cellular phone.
A 42-year-old man with the sudden appearance of angina bullosa hemorrhagica. The patient experienced pain a few minutes before the bulla appeared. He had a history of 3 similar previous episodes at the same site. Because the lesions only stay intact for a short duration, the patient took the picture using his own cellular phone. Image shows 24 hours after the initial presentation of angina bullosa hemorrhagica.
 
 
 
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