Angina Bullosa Haemorrhagica

Angina Bullosa Haemorrhagica (ABH) is a rare, benign condition of the oral mucosa, characterized by the sudden appearance of blood-filled blisters (bullae) without an identifiable cause or systemic disorder. The lesions typically rupture within a short period, leaving superficial erosions that heal without scarring.

Etiology

The exact cause of ABH remains unknown. However, it is not associated with blood dyscrasias or systemic diseases. Some researchers suggest that minor traumas, such as dental procedures or abrasive foods, could trigger the formation of blisters. Others propose that certain medications, particularly corticosteroids and anticoagulants, might predispose individuals to ABH.

Pathophysiology

ABH is thought to result from a localized trauma or irritation that leads to the separation of the epithelium from the underlying connective tissue, forming a blood-filled blister. The process is purely mechanical, and there is no evidence of an autoimmune or vasculitic component.

Clinical Presentation

Patients with ABH typically present with a sudden onset of painless, blood-filled blisters on the oral mucosa. The most common sites include the soft palate, buccal mucosa, and tongue. The blisters range in size from a few millimeters to several centimeters and rupture spontaneously within 24 to 48 hours. The underlying mucosa appears normal or slightly erythematous after rupture, and the lesions heal without scarring within a week.

Diagnosis

The diagnosis of ABH is primarily clinical, based on the characteristic appearance of the lesions and the absence of systemic disease. Laboratory tests and biopsy are not usually necessary but may be performed to rule out other conditions, such as pemphigus vulgaris, bullous pemphigoid, and hereditary angioedema.

Treatment

There is no specific treatment for ABH. Management focuses on symptomatic relief and prevention of secondary infection. Patients are advised to maintain good oral hygiene and avoid known triggers, such as hot or spicy foods. Topical antiseptics and anesthetics may be used to reduce discomfort. In cases where a specific medication is suspected to be the cause, discontinuation or substitution may be considered.

Prognosis

The prognosis for ABH is excellent. The condition is self-limiting and does not affect the overall health of the patient. Recurrences are common but can be managed with conservative measures.

Epidemiology

ABH is a rare condition, and its exact prevalence is unknown. It can occur at any age but is most commonly reported in middle-aged and elderly individuals. There is no known gender or racial predilection.

Conclusion

Angina Bullosa Haemorrhagica is a benign and self-limiting condition of the oral mucosa. Despite its alarming presentation, the prognosis is favorable, and treatment is primarily supportive. Awareness of ABH among healthcare providers is essential to avoid unnecessary investigations and interventions.

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