eMedicine Specialties > Dermatology > Diseases of the Oral Mucosa

Angina Bullosa Hemorrhagica: Differential Diagnoses & Workup

Author: Roman Carlos, DDS, 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
Contributor Information and Disclosures

Updated: May 22, 2008

Differential Diagnoses

Dermatitis Herpetiformis
Epidermolysis Bullosa
Linear IgA Dermatosis

Other Problems to Be Considered

Mucous membrane pemphigoid
Thrombocytopenia

Workup

Laboratory Studies

  • Platelet counts and coagulation tests are within normal limits.

Procedures

  • Performing a biopsy of an intact bulla is difficult because of the short duration of the lesion.

Histologic Findings

The diagnosis is essentially clinical; however, in the cases in which a biopsy has being taken, the microscopic examination reveals a subepithelial bulla filled with blood and an underlying mild and nonspecific mononuclear inflammatory cell infiltrate that generally is limited to the region of the lamina propria. Occasionally, neutrophils may be seen.8

Performing a biopsy of an intact bulla is difficult because of the short duration the lesion stays intact. Otherwise, a biopsy of a ruptured bulla exhibits just a nonspecific ulceration. According to Stephenson et al,9 direct immunostaining for immunoglobulin G, immunoglobulin A, or C3 consistently are noncontributory.

More on Angina Bullosa Hemorrhagica

Overview: Angina Bullosa Hemorrhagica
Differential Diagnoses & Workup: Angina Bullosa Hemorrhagica
Treatment & Medication: Angina Bullosa Hemorrhagica
Follow-up: Angina Bullosa Hemorrhagica
Multimedia: Angina Bullosa Hemorrhagica
References

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

  8. Kurban M, Kibbi AG, Ghosn S. Expanding the histologic spectrum of angina bullosa hemorrhagica: report of one case. Am J Dermatopathol. Oct 2007;29(5):477-9. [Medline].

  9. 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].

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

  11. 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].

  12. 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].

  13. 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].

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

  15. 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].

Further Reading

Keywords

traumatic oral hemophlyctenosis, angina bullosa hemorrhagica, angina bullosa haemorrhagica, ABH, oral blisters, localized oral purpura

Contributor Information and Disclosures

Author

Roman Carlos, DDS, 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
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.

Medical Editor

Terry L Barrett, MD, Director, Associate Professor, Department of Dermatology, Division of Dermatopathology and Oral Pathology, Johns Hopkins University School of Medicine
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.

Pharmacy Editor

David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Director, Division of Dermatology, Scott and White Clinic; Director Dermatology Residency Training Program, Scott and White 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: 3M Pharmaceutical Grant/research funds Other; Graceway Pharmaceuticals Grant/research funds Other

Managing Editor

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.

CME Editor

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

William D James, MD, Paul R Gross Professor of Dermatology, University of Pennsylvania School of Medicine; Vice-Chair, Program Director, Department of Dermatology, University of Pennsylvania Health System
William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology
Disclosure: elsevier Royalty Other; american college of physicians Honoraria Other

 
 
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