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Angina Bullosa Hemorrhagica

Definition

Angina bullosa hemorrhagica is a rare, acute, benign, oral disorder characterized by blood-filled blisters.

Etiology

The etiology is unknown. However, mild mucosal trauma and long-term use of inhaled corticosteroids have been implicated in the pathogenesis.

Main Clinical Features

•Single or multiple hemorrhagic bullae that soon rupture leaving a superficial ulcer

•Ulcer usually heals spontaneously without scarring in 5-10 days

•Soft palate and rarely, the buccal mucosa and the tongue are the areas of predilection

•Older individuals are more frequently affected

Diagnosis

The diagnosis is based mainly on the medical history and the clinical features. Biopsy, histopathologic examination, and direct immunofluorescence may be used to rule out other bullous diseases.

Differential Diagnosis

•Cicatricial pemphigoid

•Bullous pemphigoid

•Linear IgA disease

•Epidermolysis bullosa acquisita

•Oral amyloidosis

•Blood dyscrasias

Treatment

Basic Guidelines

•Patients should avoid hard foods.

•If the patient is using inhaled corticosteroids the patient’s internist or physician should be consulted before any treatment is prescribed.

Suggested Therapies

•Usually the lesions regress in a few days without any treatment.

•However, when multiple lesions appear, systemic oral corticosteroids, e.g., prednisone 10-20 mg/day for 1 week helps to heal the ulcerations sooner. This is important as multiple lesions may produce severe discomfort and pain.

•The use of mouthwashes with oxygen releasing agents (3 % hydrogen peroxide), is recommended for multiple lesions in connection with corticosteroids.

References

De las Heras ME, Moreno R, Nunez M, et al. Angina bullosa hemorrhagica, J Dermatol 1996;23:507–509.

Grinspan D, Abulafia J, Lanfranchi H. Angina bullosa hemorrhagica. Int J Dermatol 1999;38:525–528.

Guillor B. Skin reactions to inhaled corticosteroids. Clinical aspects, incidence, avoidance, and management. Am J Clin Dermatol 2000;1:107–111.

Stephenson P, lamey PJ, Scully C, et at. Angina bullosa hemorrhagica: clinical and laboratory features in 30 patients. Oral Surg Oral Med Oral Pathol 1987;63:560–565.