Diagnostic Considerations

The most recent diagnostic criteria has been proposed by Ordioni et al^[30]where a minimum of 6 out of 9 criteria should be met:

Table (Open Table in a new window)

Main criteria

(I) Clinically noticeable hemorrhagic bulla or erosion with a history of bleeding of the oral mucosa

(II) Exclusively oral or oropharyngeal localization

Additional criteria

(III) Palatal localization

(IV) Triggering event or promoting factor (food intake)

(V) Recurrent lesions

(VI) Favorable evolution without leaving a scar in a few days

(VII) Painless lesion, tingling, or burning sensation

(VIII) Normal platelet count and coagulation profile

(IX) Negative direct immunofluorescence

Differential Diagnoses

Bullous Pemphigoid
Bullous Systemic Lupus Erythematosus (BSLE)
Bullous erythema multiforme
Bullous lichen planus
Cicatricial (Mucous Membrane) Pemphigoid
Dermatitis Herpetiformis
Epidermolysis Bullosa
Epidermolysis Bullosa Acquisita
Fixed Drug Eruptions
Linear IgA Dermatosis
Pemphigus

Workup

Brajon D, Bagnères D, Berbis P, Rossi P. Angina bullosa haemorragica. J Eur Acad Dermatol Venereol. 2014 Aug 29. [QxMD MEDLINE Link].
Singh D, Misra N, Agrawal S, Misra P. Angina bullosa haemorrhagica. BMJ Case Rep. 2013 Feb 8. 2013:[QxMD MEDLINE Link].
Shoor H, Mutalik S, Pai KM. Angina bullosa haemorrhagica. BMJ Case Rep. 2013 Dec 11. 2013:[QxMD MEDLINE Link].
Dias KB, Flores AP, Oliveira MG, Carrard VC, Hildebrand LC, Sant'Ana Filho M. Angina bullosa hemorrhagica: report of 7 cases and analysis of 199 cases from the literature. Gen Dent. 2017 May-Jun. 65 (3):31-36. [QxMD MEDLINE Link].
Kurban M, Kibbi AG, Ghosn S. Expanding the histologic spectrum of angina bullosa hemorrhagica: report of one case. Am J Dermatopathol. 2007 Oct. 29(5):477-9. [QxMD MEDLINE Link].
Shashikumar B, Reddy RR, Harish M. Oral hemorrhagic blister: an enigma. Indian J Dermatol. 2013 Sep. 58(5):407. [QxMD MEDLINE Link]. [Full Text].
Pahl C, Yarrow S, Steventon N, Saeed NR, Dyar O. Angina bullosa haemorrhagica presenting as acute upper airway obstruction. Br J Anaesth. 2004 Feb. 92(2):283-6. [QxMD MEDLINE Link].
Horie N, Kawano R, Inaba J, et al. Angina bullosa hemorrhagica of the soft palate: a clinical study of 16 cases. J Oral Sci. 2008 Mar. 50(1):33-6. [QxMD MEDLINE Link].
Beguerie JR, Gonzalez S. Angina bullosa hemorrhagica: report of 11 cases. Dermatol Reports. 2014 Feb 17. 6(1):5282. [QxMD MEDLINE Link]. [Full Text].
Stephenson P, Scully C, Prime SS, Daly HM. Angina bullosa haemorrhagica: lesional immunostaining and haematological findings. Br J Oral Maxillofac Surg. 1987 Dec. 25(6):488-91. [QxMD MEDLINE Link].
Rai S, Kaur M, Goel S. Angina bullosa hemorrhagica: report of two cases. Indian J Dermatol. 2012 Nov. 57(6):503. [QxMD MEDLINE Link]. [Full Text].
Grinspan D, Abulafia J, Lanfranchi H. Angina bullosa hemorrhagica. Int J Dermatol. 1999 Jul. 38(7):525-8. [QxMD MEDLINE Link].
Silva-Cunha JL, Cavalcante IL, Barros CC, et al. Angina bullosa haemorrhagica: A 14-year multi-institutional retrospective study from Brazil and literature review. Med Oral Patol Oral Cir Bucal. 2022 Jan 1. 27 (1):e35-e41. [QxMD MEDLINE Link]. [Full Text].
Nandini DB, Pragathi MS, Sameeksh BN, Deepak BS. Recurrent episodes of angina bullosa hemorrhagica of the tongue. J Oral Maxillofac Pathol. 2022 Feb. 26 (Suppl 1):S1-S4. [QxMD MEDLINE Link]. [Full Text].
Okobi OE, Evbayekha EO, Ebili U, et al. Angina Bullosa Hemorrhagica: A Rare and Interesting Presentation. Cureus. 2022 Mar. 14 (3):e23335. [QxMD MEDLINE Link]. [Full Text].
Guillot B. Skin reactions to inhaled corticosteroids. Clinical aspects, incidence, avoidance, and management. Am J Clin Dermatol. 2000 Mar-Apr. 1(2):107-11. [QxMD MEDLINE Link].
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. 2006 Sep. 64(9):1433-6. [QxMD MEDLINE Link].
Qin R, Steel A, Fazel N. Oral mucosa biology and salivary biomarkers. Clin Dermatol. 2017 Sep - Oct. 35 (5):477-483. [QxMD MEDLINE Link].
Hosain SI, Bounds G, Stanford J. Angina haemorrhagica bullosa causing respiratory obstruction postoperatively. Anaesthesia. 1991 May. 46(5):422. [QxMD MEDLINE Link].
Garlick JA, Calderon S. Oral blood blisters in angina bullosa haemorrhagica secondary to trauma of eating and dental injection. Br Dent J. 1988 Oct 22. 165(8):286-7. [QxMD MEDLINE Link].
Corson MA, Sloan P. Angina bullosa haemorrhagica: an unusual complication following crown preparation. Br Dent J. 1996 Jan 6. 180(1):24-5. [QxMD MEDLINE Link].
Curran AE, Rives RW. Angina bullosa hemorrhagica: an unusual problem following periodontal therapy. J Periodontol. 2000 Nov. 71(11):1770-3. [QxMD MEDLINE Link].
Yadav P, Yadav A, Chander R, Sharma AK. Giant Angina Bullosa Haemorrhagica. Indian Dermatol Online J. 2020 Nov-Dec. 11 (6):1036-1037. [QxMD MEDLINE Link]. [Full Text].
de las Heras ME, Moreno R, Núñez M, Gómez MI, Ledo A. Angina bullosa hemorrhagica. J Dermatol. 1996 Jul. 23(7):507-9. [QxMD MEDLINE Link].
Higgins EM, du Vivier AW. Angina bullosa haemorrhagica--a possible relation to steroid inhalers. Clin Exp Dermatol. 1991 Jul. 16(4):244-6. [QxMD MEDLINE Link].
Hamada K, Obayashi Y, Kawahara Y, Okada H. Esophagogastroduodenoscopy-induced angina bullosa hemorrhagica of the pharynx. Ann Gastroenterol. 2020 May-Jun. 33 (3):321. [QxMD MEDLINE Link]. [Full Text].
Mehrotra R, Thomas S, Nair P, Pandya S, Singh M, Nigam NS, et al. Prevalence of oral soft tissue lesions in Vidisha. BMC Res Notes. 2010 Jan 25. 3:23. [QxMD MEDLINE Link]. [Full Text].
Raizada A, Behera D, Panda M, Debata I. Progesterone-induced Angina Bullosa Hemorrhagica. Indian J Dermatol. 2021 Jan-Feb. 66 (1):103-105. [QxMD MEDLINE Link]. [Full Text].
Domínguez JD, Rodríguez-Peralto JL, Iglesias L. Recurrent oral blood blisters. Arch Dermatol. 1999 May. 135(5):593-4, 596-7. [QxMD MEDLINE Link].
Ordioni U, Hadj Saïd M, Thiery G, et al. Angina bullosa haemorrhagica: a systematic review and proposal for diagnostic criteria. Int J Oral Maxillofac Surg. 2019 Jan. 48 (1):28-39. [QxMD MEDLINE Link].
Stephenson P, Lamey PJ, Scully C, Prime SS. Angina bullosa haemorrhagica: clinical and laboratory features in 30 patients. Oral Surg Oral Med Oral Pathol. 1987 May. 63(5):560-5. [QxMD MEDLINE Link].
Alberdi-Navarro J, García-García A, Cardona-Tortajada F, et al. Angina bullosa hemorrhagica, an uncommon oral disorder. Report of 4 cases. J Clin Exp Dent. 2020 May. 12 (5):e509-e513. [QxMD MEDLINE Link]. [Full Text].

Media Gallery

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.

of 2

Author

Kara Melissa Torres Culala, MD Training Officer, Dermatology Department, Tondo Medical Center; Faculty, Dermatology Department, Jose R Reyes Memorial Medical Center, Philippines

Kara Melissa Torres Culala, MD is a member of the following medical societies: Philippine Dermatological Society

Disclosure: Nothing to disclose.

Coauthor(s)

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

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

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Former Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Association of Military Dermatologists, Phi Beta Kappa, Texas Dermatological Society

Disclosure: Nothing to disclose.

Drore Eisen, MD, DDS Consulting Staff, Dermatology of Southwest Ohio

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

Disclosure: Nothing to disclose.

Chief Editor

Acknowledgements

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.

Angina Bullosa Hemorrhagica Differential Diagnoses

Diagnostic Considerations

Differential Diagnoses

References

Tables

Contributor Information and Disclosures

What would you like to print?