Angina Bullosa Hemorrhagica Research Articles

Angina bullosa hemorrhagica an enigmatic oral disease

Angina bullosa hemorrhagica (ABH) is an enigmatic oral disorder described for the first time by Badham in 1967 to define blisters with a hematic content in the oral cavity and oropharynx unrelated to any hematological, dermatological or systemic disease. The ABH is an uncommon disease of the oral cavity distinctively affecting adults, with the highest incidence over the 5 decade of life. This process is considered nowadays to have a multifactorial etiopathogenesis, where mild oral traumatisms can trigger the blisters in susceptible individuals. Certain association on the onset of the lesion with the chronic use of inhaled steroids and, more controversially, with triggering systemic disorders, such as, diabetes or hypertension has been described. Characteristically, the ABH blisters are acute and are located on the lining mucosa, more frequently on the soft palate. Usually, the lesions are solitary and rupture easily, resulting in a superficial ulceration that heals quickly without scarring. The histopathological analysis shows a subepithelial blister containing blood and direct immunofluorescence on the epithelium is negative. The differential diagnosis should consider all oral vesiculobullous disorders with hematic content, including mucocutaneos, hematological or cystic pathology. The diagnosis of ABH is clearly clinical, although the biopsy might be helpful on atypical or abnormally recurrent cases. The general prognosis of ABH is good and the treatment is symptomatic.

Angina bullosa hemorrhagica: a rare condition?

Angina bullosa hemorrhagica is characterized by oral mucosal blood-filled vesicles or blisters. These lesions, however, are frequently asymptomatic and they are only observed when their content is spilled over the oral cavity. Objective: The aim of this study was to perform a retrospective evaluation of Angina Bullosa Hemorrhagica (ABH) cases diagnosed in patients referred to the Diagnosis Center of Oral Diseases of the Dentistry School of Federal University of Pelotas, over a 4-years period. Material and methods: All the clinical records from this period were reviewed and Angina Bullosa Hemorrhagica could be diagnosed in 47 patients. The following information pertaining to the patient and the lesion were collected from the dental record: gender, age, ABH site, size of the lesion, presence of symptoms, bleeding, likely predisposing factors, treatment and recurrence of the lesion. Results: The results revealed 47 patients with clinical features of ABH, 26 were female and 21 were male, with ages between 42 to 87 years. Thirty-six patients (76.6%) developed the lesion in the palate. Pain was reported by 17 patients (36.2%) and bleeding by 19 patients (40.4%). Seventeen patients (36.2%) reported the occurrence of the lesion following trauma. Conclusion: It is possible to conclude that although ABH has been traditionally described as a rare condition, the data obtained in this study suggest a fairly high occurrence of the disease.

Blood Filled Blister in the Oral Mucosa - A Diagnostic Challenge

Angina bullosa Hemorrhagica is characterized by the acute formation of a blood filled blister not attributable to a systemic disorder. The pathogenesis is unknown, however it is multifactorial. The most common cause is trauma prior to the appearance of the lesion. They occur mainly in the soft palate; lesions are asymptomatic and heal spontaneously without scarring. This case report discusses angina bullosa hemorrhagica which occurred due to stretching of buccal mucosa by mouth mirror during clinical examination.

Oral hemorrhagic blister: An enigma

Angina bullosa hemorrhagica (ABH) is a disorder of unclear aetiology characterized by abrupt and unprovoked presentation of blood-filled blister over the oral mucosa. Histopathology reveals sub epithelial blister containing erythrocytes with superficial perivascular lymphocytic infiltrate. We report two cases of ABH of which one was idiopathic and other was associated with chronic renal failure on hemodialysis.

Angina Bullosa Hemorrhagica with a Possible Relation to Dental Treatment, Diabetes Mellitus, Steroid Inhaler and Local Trauma: Report of 3 Cases

In 1967, Badham advocated the term angina bullosa hemorrhagica (ABH) for an oral mucosal blood blister that occurs with no evidence of blood dyscrasias or vesiculobullous disorder. Clinically, ABH is a solitary and often painful lesion, primarily affecting soft palate of middle-aged adults. Multiple lesions are exceptional and repeated occurances have been reported in few cases.1,2 ABH heals spontaneously, but for advanced lesions with suspected airway obstruction active treatment is recommended. Although, the diagnosis is nonproblematic in most cases and it is important to critically distinguish ABH from more serious conditions, including various hemorrhagic disorders and bullous diseases. As to etiopathogenesis of ABH, local mucosal trauma, underlying systemic diseases and the use of long-term steroid inhalers have been suggested.2 In the present case reports, we were able to identify the causative agents to be local mucosal trauma secondary to oral prophylaxis in case 1, underlying systemic illness in the form of diabetes mellitus and bronchial asthma for which the patient was using steroid inhaler in case 2 and local trauma secondary to coarse food in case 3.

Prevalence of oral soft tissue lesions in Vidisha

BackgroundThe purpose of this study was to determine the prevalence of oral soft tissue lesions in patients and to assess their clinicopathological attributes. 3030 subjects belonging to a semi-urban district of Vidisha in Central India were screened. Patients were examined with an overhead examination light and those who were identified with a questionable lesion underwent further investigations. Statistical analysis was done using the SPSS software.Findings8.4 percent of the population studied had one or more oral lesions, associated with prosthetic use, trauma and tobacco consumption. With reference to the habit of tobacco use, 635(21%) were smokers, 1272(42%) tobacco chewers, 341(11%) smokers and chewers, while 1464(48%) neither smoked nor chewed. 256 patients were found to have significant mucosal lesions. Of these, 216 cases agreed to undergo scalpel biopsy confirmation. 88 had leukoplakia, 21 had oral submucous fibrosis, 9 showed smoker's melanosis, 6 patients had lichen planus, 17 had dysplasia, 2 patients had squamous cell carcinoma while there was 1 patient each with lichenoid reaction, angina bullosa hemorrhagica, allergic stomatitis and nutritional stomatitis.ConclusionsThe findings in this population reveal a high prevalence of oral soft tissue lesions and a rampant misuse of variety of addictive substances in the community. Close follow up and systematic evaluation is required in this population. There is an urgent need for awareness programs involving the community health workers, dentists and allied medical professionals.

Angina bullosa hemorrhagica of the soft palate: a clinical study of 16 cases

Angina bullosa hemorrhagica (ABH) is an oral mucosal blood blister that develops without blood dyscrasia or vesiculobullous disorder. Although a minor mucosal trauma has been suggested as a triggering factor for ABH, its etiopathogenesis, especially the causative role of systemic conditions, is largely unknown. We investigated the presence or absence of local factors as well as systemic background disease in 16 patients with ABH arising in the soft palate. All the lesions were solitary, and 75% of them (n = 12) appeared during the ingestion of hard or crispy food. With regard to underlying systemic conditions, hypertension was the most common (n = 6), and asthma, insomnia, diabetes mellitus, rheumatoid arthritis, gastrointestinal disorder and hyperuricemia were also recorded (n = 1 each). Five patients had no significant background disease. There were no recalcitrant or recurrent cases. In conclusion, the present study has revealed that scratching of the oral mucosa during eating plays an important role in the formation of ABH. Hypertension appears to be the most frequent background condition, but its pathogenic relationship with ABH remains speculative, as hypertension is fairly common in adults.

Angina Bullosa Hemorrhagica of the Soft Palate: Report of 11 Cases and Literature Review

c b i l g l ngina bullosa hemorrhagica (ABH), first described y Badham, is a disorder characterized by the acute ormation of a blood-filled blister in the oral and ropharyngeal mucosa. Lesions of ABH occur mainly n the soft palate. Elderly patients are usually afected. Lesions are asymptomatic and heal spontaeously without scarring. The pathogenesis of ABH s unknown; however, it may be multifactorial. Loal trauma seems to be a major provoking factor; ther factors such as long-term use of steroid inhalers nd diabetes mellitus also may be contributory. o consistent hematologic or immunopathogenic facors have been found to be associated with ABH. lthough most cases of ABH require no treatment, esions could cause acute airway obstruction. In this report, we describe 11 cases of ABH exerienced in our clinic. We also review the literaure with regard to the clinical features, pathogensis, differential diagnosis, and management of the BH.

Skin reactions to inhaled corticosteroids. Clinical aspects, incidence, avoidance, and management.

Inhaled corticosteroids are considered by many to be the therapy of choice in the treatment of asthma and allergic rhinitis. Systemic adverse effects are well known and are mainly dose dependent. Adverse cutaneous effects have also been characterized. Some of them are frequent and dose dependent, for example thinning of the skin and easy bruising. These adverse effects are probably present in about half of the patients treated with inhaled corticosteroids. The risk of these adverse effects is more important among elderly people and increases with the duration of the treatment and the daily dosage. Thinning of the skin and easy bruising are probably dependent on collagen synthesis modifications. Among rare or underestimated reactions, several adverse effects have been described such as angina bullosa hemorrhagica, acne and allergy. In this latter case, the attention should be paid to relevant clinical signs such as eczematous lesions of the face and aggravation of the nasal symptoms. Mucocutaneous infections related to inhaled corticosteroid use have also been reported, the most frequent being candidiasis. However, the frequency of symptomatic clinical infection is very rare. The risk of viral infection, especially with a herpes virus, has never been described. As cutaneous complications of corticosteroids are mainly dose dependent, these adverse effects could be prevented by attention to the daily dosage. Infection could be prevented by rising the mouth after inhalation and the use of a spacer device. If cutaneous adverse effects occur despite proper use of the inhaled corticosteroids and became unpleasant for the patient, discussion with a pneumologist or otorhinolaryngologist may be required but temporary halting therapy is rarely useful.

Angina bullosa hemorrhagica.

In 1967, Badham used the term angina bullosa hemorrhagica (ABH) to describe an entity we already knew as traumatic oral hemophlyctenosis (TOH) (1933) and later renamed recurrent oral hemophlyctenosis (ROH) (1971). The objective of this study was to review and discuss the literature, and to report 54 new cases seen between 1989 and 1996. Fifty-four patients were thoroughly assessed to determine the clinical features, histology, etiology, pathogenesis, differential diagnosis, and therapy. In 35 patients (64.8%), the lesions predominated on the palate and in nine (16.6%) on the oral mucosa. The incidence was similar in both sexes (women, 52%; men, 48%) and the condition affected mostly the 51-70-year age group. ABH was never documented in children under 10 years of age. In 24 cases (44.4%), diabetes mellitus, hyperglycemia, and/or a family history of diabetes was found. ABH is a disorder more common than the literature would suggest. Although the causes may be multiple (mucosal trauma, inhaled corticosteroids), the available data indicate that, in these patients, the presence of an alteration in glucose metabolism should be considered.