|Angina Bullosa Hæmorrhagica
(Oral Blood Blisters)
Angina Bullosa Hæmorrhagica (Angina 'choking /
strangling', bullosa 'a blister' & hæmorrhagica
'blood-filled', initially termed as traumatic oral
hæmophlyctenosis) is the term used to describe
benign and generally, sub-epithelial oral mucosal
blisters filled with blood, which are not attributable to a
systemic disorder or hæmostatic defect (clotting
The blood blisters may be confused with other more
serious disorders (e.g., dermatitis herpetiformis,
epidermolysis bullosa acquisita, mucous membrane
pemphigoid, cicatricial pemphigoid, pemphigoid
amyloidosis, blood dyscrasias) however, the isolated
nature, rapid healing and rare recurrence of ABH blisters
generally are sufficient findings to rule out the previously
The lesions maybe indistinguishable from blood blisters
related to low level of platelets (thrombocytopænia)
however blood tests and the absence of areas of bruising
(ecchymosis), nose bleeds (epistaxis) or bleeding from the
gums are helpful signs to rule it out.
Angina bullosa hæmorrhagica (ABH) is a rare acute and
benign blood blistering oral disorder that predominantly
affects middle-aged or elderly people (60% of the patients
in the range of 45 - 70 years). Both sexes are equally
|Photo of ABH on the left lateral border of the tongue
|Last Updated 15th December 2014
|Photo of ABH on the left soft palate
|What are the signs and symptoms of Angina Bullosa Hæmorrhagica (ABH)?
Some patients 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.
Patients do not report a tendency to bleed at other sites.
Family history generally is non-contributory (though there is a suggestion that it can
be associated with type II diabetes, hyperglycemia or a family history of diabetes
however there is no conclusive evidence of a cause-and-effect relationship
between the presence of ABH and glucose metabolism).
- The lesions reach an average size of 1 - 3 cm in diameter.
- The soft palate is the most commonly affected site. 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 blood blisters in more than one
- The oral mucosa attached to bone (ie, ‘masticatory mucosa’ represented by
the hard palate and gums) is not affected.
- Similar lesions in other mucous membranes or the skin have not been reported.