|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 disorder).
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 mentioned conditions.
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 29th December 2019
|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 location.
- The oral mucosa attached to bone (ie, ‘masticatory mucosa’ represented by the hard palate and gums) is not
- Similar lesions in other mucous membranes or the skin have not been reported.