He had a 39C fever and severe sepsis clinical criteria. The patient did not notice any drainage from any injection site. WebPuffy hand syndrome, a common complication of IV drug use, is not a well-recognized condition among general practitioners. government site. National Library of Medicine Buprenorphine intravenous misuse has also been suspected to be involved in lymphatic destructions due to its lack of solubility, but this hypothesis has not been statistically confirmed. Bookshelf Bacteriologic examination of a closed bullous lesion evidenced a methicillin-sensitiveStaphylococcus aureus. Puffy-hand sign of drug addiction. Unable to load your collection due to an error, Unable to load your delegates due to an error. Puffy hand syndrome is painless, and it may present either during or following a lengthy period of drug addiction. Awarded Joint Commission, CARF & Expertise Accreditation. Give us a call today to verify your insurance coverage or to learn more about paying for addiction treatment. Histologic findings of puffy hand syndrome. WebDescription. 2013;2013:376060. doi: 10.1155/2013/376060. Puffy hand syndrome is a rare manifestation due to continuous intravenous drug abuse. FOIA Most insurance is accepted including: BCBS, United, UMR, Cigna, Aetna, and more. 6 In intravenous drug use, puffy hand syndrome is recognized because of repeated injections into the hand, characterized by swelling of the hand and forearm, with traumatic disruption of deep lymphatics. Pathophysiology of puffy hand syndrome involves sclerosis and damage of veins and lymphatic vessels after repeated drug injections, leading to lymphoedema. Common causes of a single swollen extremity includes skin and soft-tissue infection, trauma and deep vein thrombosis and must be considered especially in patients with history of intravenous drug use (DU), however, puffy hand syndrome is a lesser-known complication of intravenous DU that may present similarly. The differential diagnosis for puffy hand syndrome typically includes lymphangitis, venous thrombosis, heart failure, renal insufficiency, liver failure, erythromelalgia, scleroderma, rheumatoid arthritis, and systemic lupus erythematosus (SLE) [6]. In one patient, the edema was localized both in the hands and in the feet. In our patient with a history of IVDU, we propose that physiologic hypervolemia of pregnancy5 accelerated the onset of her symptoms by overwhelming the capacity of weakened lymphatics and veins. Ultrasound showed occlusive cephalic vein thrombosis in the right upper extremities, without any evidence of thrombosis in the lower extremities. WebCommon causes of a single swollen extremity includes skin and soft-tissue infection, trauma and deep vein thrombosis and must be considered especially in patients with history of intravenous drug use (DU), however, puffy hand syndrome is a lesser-known complication of intravenous DU that may present similarly. This field is for validation purposes and should be left unchanged. Common risk factors for puffy hand syndrome include female gender, injection in hands, and poor antiseptic technique [3]. If you are affected by this condition, your fingers and hands will be swollen. [5] Pieper, Barbara et al. -, del Giudice P., Durant J., Dellamonica P. Hand edema and acrocyanosis: puffy hand syndrome. Feet involvement is less frequent, related to the lower limbs injections. and transmitted securely. Musculoskeletal findings associated with SLE include generalized arthralgia that can be accompanied by morning stiffness [7]. 2020;25(1):92. HHS Vulnerability Disclosure, Help 8600 Rockville Pike We want to acknowledge our patient without whom this report would not have been possible. Histologic findings of puffy hand syndrome. -. government site. Disclaimer. Red puffy hand syndrome is an uncommon clinical manifestation of intravenous drug abuse, which presents with bilateral, painless and non-pitting erythema and edema of the dorsal hands. This site needs JavaScript to work properly. WebPuffy hand syndrome is a rare entity associated with intravenous drug use (IVDU) that was first described in 1965 and affects between 7% and 16% of intravenous drug users., Heroin is a lethal and extremely addictive drug. WebPuffy hand syndrome secondary to intravenous drug use presenting in pregnancy and persisting postpartum. Epub 2011 Dec 6. sharing sensitive information, make sure youre on a federal Please enable it to take advantage of the complete set of features! This painless syndrome appears during or after a long period of drug addiction. Ezzo J, Manheimer E, McNeely ML, Howell DM, Weiss R, Johansson KI, Bao T, Bily L, Tuppo CM, Williams AF, Karadibak D. Cochrane Database Syst Rev. Red puffy hand syndrome mistaken for inflammatory arthritis. The places on the body people most commonly inject illicit drugs are the arms, hands, and feet. Ann Dermatol Venereol. sharing sensitive information, make sure youre on a federal Epub 2009 Feb 11. According to the National Highway Traffic Safety Administration, Emergency Medical Services (EMS) cover ascope of treatmentthat allows first responders to administer medication through an intravenous line. [Puffy hand syndrome in drug addiction treated by low-stretch bandages]. Accessibility There is evidence that more than 60% of new hepatitis C patients injected drugs during the prior 6 months. Puffy hand syndrome has no specific treatment available. Intravenous drug addiction; Puffy hand syndrome; Syndrome des grosses mains; Toxicomanie. Deep vein thrombosis of the lower limbs in intravenous drug users. Amode R, Bilan P, Sin C, Marchal A, Sigal ML, Mah E. Case Rep Dermatol Med. eCollection 2022 May. It affects between 7% and 16% of intravenous drug users [4]. Drug Alcohol Depend. HHS Vulnerability Disclosure, Help Prolonged and frequent intravenous (IV) drug use may cause permanent damage to the veins at drug injection sites. Alcohol Detox We report two cases of this condition from our rheumatologic consultation. This syndrome has to become more The .gov means its official. HHS Vulnerability Disclosure, Help Some conditions, such as ablood clot from IV drug use, can be fatal. Furthermore, it has been demonstrated by lymphoscintigraphy evaluation that skin infections, common in drug addicts, provoke lymphatic damages; most patients with repeated erysipelas have significant and even permanent abnormalities in regional lymphatic drainage. Dr. Hans Abeles, the Commissioner of Health for the Department of Corrections in New York City, initially described puffy hand syndrome in 1965 [1]. The same studies indicate that people who regularly use drugs and suffer from vein damage will seek alternate veins, spreading the damage to other parts of the body. A 35-year-old woman with a history of bipolar I disorder and chronic joint pain presented to the dermatology clinic with a 15-month history of swelling and redness of her hands. MeSH Accessibility This form of drug abuse is especially damaging to the skin, leaving track marks at the injection site. Disclaimer. In general, prevention of skin infections and cold environments can be considered. All of these conditions negatively impact health and longevity. Intravenous injections of drugs can cause Federal government websites often end in .gov or .mil. Puffy hand syndrome seen in intravenous drug addicts is poorly understood. It's confidential. The https:// ensures that you are connecting to the Dans ce contexte, le puffy hand syndrome occupe une place particulire. The comprehensive metabolic panel was unremarkable. Address: 31631 Auto Center Dr,Lake Elsinore, CA 92530. It typically presents with bilateral, non-pitting edema at The frequency and severity of the complications of this syndrome are rarely reported. Firstly described by Abeles in 1965 in New York prisoners, it could affect from 7 to 16% intravenous drug users [1, 2]. The four limbs simultaneous erythema and bullous lesions, abdominal pain, and severe sepsis were considered to be toxic complications. Epub 2013 May 29. Panic Disorder WebPuffy hand syndrome is a complication of intravenous drug misuse. Here was reported a case of puffy hand syndrome revealed by a severe staphylococcal infection with toxic complications mimicking a four limbs cellulitis. Initially, doctors prescribed this substance as a prescription painkiller, but the, Black tar heroin significantly differs in appearance from the typical powdered white or brown form of the drug. [Puffy hand syndrome: A little-known diagnosis]. Amode R, Bilan P, Sin C, Marchal A, Sigal ML, Mah E. Red puffy hand syndrome mistaken for inflammatory arthritis. anxiety Dextrose 10% in the treatment of out-of-hospital hypoglycemia. Prehospital Disaster Medication. government site. Unauthorized use of these marks is strictly prohibited. [Puffy hand in long-term intravenous drug users]. Here, we present the case of a homeless 27-year-old presenting with asymmetric edema in his extremities. 2009 May;43(5):973-7. doi: 10.1345/aph.1L628. This is what causes the swelling that affects between 7% and 16% of intravenous drug users. WebPuffy hand syndrome, a common complica-tion of IV drug use, is not a well-recognized condition among general practitioners. 2013;2013:376060. doi: 10.1155/2013/376060. official website and that any information you provide is encrypted 2006 Sep;101(9):1347-51. doi: 10.1111/j.1360-0443.2006.01521.x. Bethesda, MD 20894, Web Policies Borderline Personality Disorder Symptoms He reported progressive swelling of both upper extremities and left lower extremity a month prior to his presentation. She denied any exacerbating factors, including temperature change. Puffy hand syndrome is an unrecognized complication of intravenous drug abuse. National EMS Scope of Practice Model.. She endorsed chronic joint pain in her hands and back. Epub 2008 Oct 14. The pathogenesis of this edema is probably multifactorial: venous, lymphatic insufficiency and the direct toxicity of injected drugs. PMC Alcohol Detox California Nonspecific findings of punch biopsy showed small vessel ectasia and minimal perivascular lymphocytic infiltrate. [1] Ciccarone, Daniel et al. 2008 Jul-Aug;8(4):287-313. doi: 10.1111/j.1533-2500.2008.00204.x. Arch Dermatol. Puffy hand syndrome is a complication of intravenous drug abuse, which has no current available treatment. Other issues may include: Puffy hand syndrome develops after long-term intravenous drug addiction. Creatinine levels, hepatic function tests, and hepatitis panels drawn 6months prior were all normal. Calls Are Confidential. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. The abdomen computed tomography excluded deep abscesses or peritoneal effusion. Hand circumference decreased 4.3 cm on the left side and 3.2 cm on the right side in case 1, and 2.5 cm and 1.9 cm respectively for case 2. We hypothesized that injections of high-dose sublingual buprenorphine, instead of 2014 Sep;23(10):1069-72. doi: 10.1177/0961203314533601. Observation 1 Varescon I, Vidal-Trcan G, Nabet N, Boissonnas A. Encephale. Epub 2009 Apr 21. Unauthorized use of these marks is strictly prohibited. The patient was diagnosed with puffy hand syndrome. Lymphedema volumes calculated by utilizing the formula for a truncated cone decreased by 16% on the left side and 12% on the right side for the first patient and 31 and 17% for the second. Unfortunately, these clinical findings are commonly misdiagnosed and persist for years before a correct diagnosis is made. These clinical symptoms are typically found on the dorsum of the hands [4]. Unable to load your collection due to an error, Unable to load your delegates due to an error. Injecting heroin, meth, or cocaine is one of the most dangerous patterns of substance use, and swollen hands are one of the less reported side effects. official website and that any information you provide is encrypted The site is secure. The diagnosis of puffy hand syndrome is one of exclusion; laboratory findings tend to be ambiguous. Gaghan LJ, Bode HP, Mervak JE. Please enable it to take advantage of the complete set of features! Animal experiments have shown lymphedema is reproducible using recurrent direct blows to the upper limb. Two years later, during the second trimester of pregnancy, persistent edema with new erythema of hands and feet developed. Synovitis with pitting edema as the presenting manifestation of systemic lupus erythematosus. Opioids and the management of chronic severe pain in the elderly: consensus statement of an International Expert Panel with focus on the six clinically most often used World Health Organization Step III opioids (buprenorphine, fentanyl, hydromorphone, methadone, morphine, oxycodone). Dermatol Online J. Would you like email updates of new search results? Unilateral Swollen Hand: A Rare Case of Primary Lymphedema Tarda. Unable to load your collection due to an error, Unable to load your delegates due to an error. official website and that any information you provide is encrypted It is a form of lymphedema caused by the sclerosing nature of intravenously administered drugs. Epub 2013 Oct 2. If you develop permanent puffy hand syndrome, further side effects may present, including: Any intravenous drug use is liable to cause skin damage and will also accelerate the development of substance use disorder. Bookshelf Rev Med Interne. Systemic lupus erythematosus: clinical presentations. Obsessive-Compulsive Disorder government site. Hegazi MO, Saleh F, Al Rashidi A, Yaktien MM. Puffy hand syndrome is a long-term complication of intravenous drug abuse. and transmitted securely. How Much Alcohol Causes Cirrhosis Erythema and abdominal pain regressed within a few days. sharing sensitive information, make sure youre on a federal We studied the pathogenesis of puffy hand syndrome of intravenous drug use. WebPuffy hand syndrome may cause swelling in one hand. 2009 May;30(5):460-4. doi: 10.1016/j.revmed.2008.11.011. Part of the requirement for an EMS is that they are capable of establishing and maintaining access to medication through a patients veins. Bethesda, MD 20894, Web Policies government site. 2018 Jul-Dec;27(2):296-301. doi: 10.4103/ipj.ipj_53_17. Careers. The .gov means its official. Red puffy hand syndrome, albeit rare, is an important manifestation of intravenous drug abuse; its recognition will spare patients from unnecessary systemic treatments. Bookshelf Bookshelf Before Federal government websites often end in .gov or .mil. 2. Skin manifestations include malar rash or photosensitive rashes that can last for several weeks after sun exposure. The Journal of the American Medical Association has outlined the samemethodsince the 1950s for starting intravenous drugs in a collapsed vein. Feel free to call us to speak with one of our counselors. Renaissance Recovery Heroin Addiction Heroin Effects Puffy Hand Syndrome. However, addiction specialists, dermatologists, HHS Vulnerability Disclosure, Help An official website of the United States government. An official website of the United States government. 2009 May;30(5):460-4. doi: 10.1016/j.revmed.2008.11.011. Treatment regimens for puffy hand syndrome are non-specific. The https:// ensures that you are connecting to the The site is secure. Multiple factors influence the level of damage from injecting drugs. They were past heroin users, mainly methadone-substituted. doi: 10.7759/cureus.25453. Owing to an elevated rheumatoid factor, which would later be attributed to patient's untreated hepatitis C, these findings were mistaken for rheumatoid arthritis and unnecessarily treated with methotrexate and prednisone. The .gov means its official. This site needs JavaScript to work properly. JAAD Case Rep. 2021 Jul 10;14:124-126. doi: In multivariate analysis, sex (women) (OR = 8.9, P = 0.03), injections in the hands (OR = 5.9, P = 0.03), injections in the feet (OR = 6.5, P = 0.01) and the absence of tourniquet (OR = 7.0, p = 0.02) were significant risk factors for puffy hand syndrome. 1 Disclaimer. You can get rid of puffy eyes in many ways, from improving your sleep or applying a cold compress to using topical medications or Manual lymphatic drainage for lymphedema following breast cancer treatment. Epub 2009 Feb 11. Epub 2020 Jul 14. Lymphedema and lipedema - an overview of conservative treatment. Vein damage from IV drug usehas significant repercussions for health. sharing sensitive information, make sure youre on a federal The content published in Cureus is the result of clinical experience and/or research by independent individuals or organizations. Arm and forearm edema are voluminous and You should permanently stop the intravenous injection of drugs. Would you like email updates of new search results? A 27-year-old, homeless, Caucasian male presented to an urgent care with erythema and edema in his extremities and a small abscess with surrounding cellulitis on his right hand. 31631 Auto Center Dr Abeles H. Puffy hand syndrome revealed by a severe staphylococcal skin infection. Rev Med Interne. Before Unauthorized use of these marks is strictly prohibited. Accessibility Puffy hand syndrome develops in long-term intravenous drug users. Elastic gloves were fitted at the end of treatment. edema, heroin, intravenous drug use, lymphedema, postpartum, pregnancy, puffy hand syndrome, swollen hands, Dean S.M. Repeated injections of drugs in or outside the veins destroy the lymphatics. Bethesda, MD 20894, Web Policies The nonsteroidal anti-inflammatory treatment could have been an aggravating factor. Puffy Hand Syndrome and Prescription Drug Addiction Nonspecific findings of punch biopsy showed small, MeSH 2017;27(4):415417. 2008 Jul;15(4):227-39. doi: 10.1007/s10140-008-0709-2. We included 33 cases and 33 controls, mean age of 34 years. eCollection 2021 Aug. The most prominent risk factor for puffy hand syndrome is the injection of narcotics into the hands or feet. Careers. 2009 Jan;38(1):153-5. doi: 10.1016/j.lpm.2008.04.009. government site. Clipboard, Search History, and several other advanced features are temporarily unavailable. An echocardiogram showed a normal ejection fraction. Disclaimer. Knowledge of this disorder should prompt dermatologists to ask the applicable social history questions and prevent inappropriate and aggressive treatments for alternative diagnoses. By identifying what triggers substance use and by learning healthier coping mechanisms, you will build the skills you need to cope with stress in sober living. Either way, there are very limited options if there is severe vein damage, and these solutions may be too little too late. Puffy hand syndrome can present during or after bouts of intravenous drug abuse with intermittent non-pitting edema [3]. IV drug use vein damageis a serious challenge to the administration of life-saving drugs in the event of a medical emergency. Anxiety Disorder 2013 Sep;32(4):251-4. doi: 10.1016/j.main.2013.05.001. PMC Red puffy hand syndrome mistaken for inflammatory arthritis. In some cases, this occurs years after someone quits intravenous drug use. Careers. Puffy hand syndrome due to drug addiction: a case-control study of the pathogenesis. Careers. Lymphatic destruction and obstruction have also been theorized as modes of pathogenesis for puffy hand syndrome [5]. 2009 May;30(5):460-4. doi: 10.1016/j.revmed.2008.11.011. According to this study, puffy hand syndrome is a rare complication of chronic intravenous drug abuse. Conclusions: Keywords: Would you like email updates of new search results? Epub 2013 Oct 2. Aim: We studied the pathogenesis of puffy hand syndrome of intravenous drug use. Disclaimer. An official website of the United States government. 2009 May;30(5):460-4. doi: 10.1016/j.revmed.2008.11.011. Simonnet N, Marcantoni N, Simonnet L, Griffon C, Chakfe N, Wertheimer J, Stephan D. J Mal Vasc. If you are unable to access our treatment center, inquire about our virtual intensive outpatient programs. eCollection 2015. Dentistry, Midwestern University Chicago College of Osteopathic Medicine, Chicago, USA. [Puffy hand in long-term intravenous drug users]. Research reported the case of a 41-year-old man who went to the emergency department for abdominal pain, fever, and bullous lesions of legs and arms with edema. The edema was not pitting and unaffected by elevation. Simonnet N, Marcantoni N, Simonnet L, Griffon C, Chakfe N, Wertheimer J, Stephan D. J Mal Vasc. WebPuffy hand syndrome is a rare entity associatedwith intravenous drug use (IVDU) that was rstdescribed in 1965 and affects between 7% and 16%of intravenous drug users.1,2Clinical findings includepainless, nonpitting edema and erythema of thedorsal side of bilateral hands, often beginning yearsafter cessation of IVDU.3The pathophysiology MeSH The subjects were asked to answer anonymously a questionnaire of 40 items comprising social and demographic status, history of illicit drugs use, buprenorphine misuse and injection practices. Bacteriologic examination of a closed bullous lesion evidenced a methicillin-sensitiveStaphylococcus aureus. To kickstart your recovery today before puffy hand syndrome sets in, reach out to Renaissances Laguna Beach rehab at 866.330.9449. Federal government websites often end in .gov or .mil. HHS Vulnerability Disclosure, Help Bethesda, MD 20894, Web Policies Aslam A, Rather S, Hussain A, Younus F, Saqib NU, Hassan I. Indian Dermatol Online J. Red puffy hand syndrome is an uncommon clinical manifestation of intravenous drug abuse, which presents with bilateral, painless and non-pitting erythema and edema of the dorsal hands. solution. She described injecting routinely into the dorsal side of bilateral hands, wrists, and ventral side of forearms. Unable to load your collection due to an error, Unable to load your delegates due to an error. Local infectious complications such as cellulitis can be severe and can enable the diagnosis. It is a rare complication that carries the potential of being confused with systemic sclerosis, rheumatoid arthritis, or erythromelalgia. Pitting edema in the right hand was seen with volar erythema. Before Low-stretch bandage and elastic garment, usually used in lymphedema treatment, are proposed to treat the puffy hand syndrome. Unauthorized use of these marks is strictly prohibited. 2011 Jul;40(4):271-9. doi: 10.1024/0301-1526/a000115. Accessibility Some implicated risk factors for puffy hand syndrome include female gender, repeated injections in the hands and feet, and the absence of tourniquet use [5]. Initially, cellulitis was suspected due to edema and erythema, mild leukocytosis, and neutrophilia. The generalized presentation factors of SLE include fatigue, fever, lymphadenopathy, and weight loss. It is a nonpitting or slightly pitting, affecting the dorsal side of fingers and hands with puffy aspect, sometimes asymmetric (more important in the nondominant member), with skin thickness. Puffy hand syndrome is defined by symmetric, painless erythema and edema of the hands in patients with a history of intravenous drug use. An official website of the United States government. Red puffy hand syndrome is an uncommon clinical manifestation of intravenous drug abuse, which presents with bilateral, painless and non-pitting erythema and edema 2006 Oct;133(10):769-72. doi: 10.1016/s0151-9638(06)71040-7. drug addiction The https:// ensures that you are connecting to the The patient also reported using new needles and injecting heroin in all four extremities. The https:// ensures that you are connecting to the and transmitted securely. Three years after the cessation of IVDU, she experienced an intermittent and gradual onset of painless, symmetric swelling of both hands. Epub 2009 Feb 11. 1 In a case-controlled study of 66 patients, multivariate analysis identified the following risk factors for PHS: (1) female sex (odds ratio (OR) = 8.9, p = 0.03); (2) absence Andresz V, Marcantoni N, Binder F, Velten M, Alt M, Weber JC, Stephan D. Addiction. Lower and upper limb venous doppler excluded deep venous thrombosis. Treatment included daily multilayer bandaging. 2006;142(8):10841085. These include things likehypoglycemiatreatment. It is characterized by nonpitting edema, affecting the dorsal side of fingers and hands with a puffy aspect. There could be a number of reasons for coke bloat, from fluid retention to hormonal issues. WebPMID: 15529083 DOI: 10.1016/s0398-0499(04)96748-0 Abstract Narcotic addiction may induce systemic and local complications. The infectious disease team was consulted for further evaluation. Kovcs A.L., Rzsa A., Klmn E., Gymrei C., Schmidt E., Gyulai R. Puffy hand syndrome. Cardiovascular physiology of pregnancy. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Common options include compression garments, lymphedema physical therapy, and lymphatic massage. Discussion: Sanghavi M., Rutherford J.D. 24-Hour Helpline. The https:// ensures that you are connecting to the Symptoms will likely get worse with ongoing drug use. He denied fever, chills, shortness of breath, pleuritic chest pain, orthopnea, dyspnea on exertion, or any urinary symptoms. The .gov means its official. Acute kidney injury due to rhabdomyolysis in narcotic drug users. 1. Here, we present the case of a homeless 27-year-old presenting with erythema and edema in his extremities. PMC Heroin addiction was substituted by buprenorphine, without buprenorphine intravenous injection. Webintravenous drug use (DU), however, puffy hand syndrome is a lesser-known complication of intravenous DU that may present similarly. Bethesda, MD 20894, Web Policies The site is secure. Clipboard, Search History, and several other advanced features are temporarily unavailable. As a library, NLM provides access to scientific literature. Consent was obtained or waived by all participants in this study, National Library of Medicine On presentation, the patient was afebrile and saturated 98% on room air. Careers, Unable to load your collection due to an error. We report two cases of this condition from our rheumatologic Bookshelf Impact of injection drug use on distribution and severity of chronic venous disorders. Wound Repair and Regeneration. Cutaneous findings of puffy hand syndrome. Buprenorphine in primary care: risk factors for treatment injection and implications for clinical management. It is a form of lymphedema caused by the sclerosing nature of intravenously administered drugs. WebAbstract Background: Puffy hand syndrome is a complication of intravenous drug abuse, which has no current available treatment. We Level Up CA Rehab Addiction Detox Center. Intravenous injections of drugs can cause venous thrombosis, and septic or embolic complications. It is a chronic complication despite the cessation of drug use. Lab tests were normal, and imaging revealed soft-tissue swelling. Arthur C Huntley MD, California Digital Library. 2013 Sep;32(4):251-4. doi: 10.1016/j.main.2013.05.001. The associated swelling can mask the associated tendons and veins on the dorsum of the hands and feet [5]. solution. Our specialists know what you are going through. He had a previous history of HCV hepatitis and intravenous heroin addiction cured fifteen years ago. Courtin C, Mathieu L, Rongiras F, Bertani A, Chauvin F. Chir Main. This syndrome has to become more widely known because its management is mandatory, although symptomatic. Arm and forearm edema are voluminous and cause functional and aesthetic disturbances. Accessibility A woman and two men, aged 42, 39 and 36 years old, are described. We retained the diagnosis of puffy hand syndrome revealed by a severe staphylococcal infection with toxic involvement mimicking a four limbs cellulitis. This site needs JavaScript to work properly. He stated that he injected heroin the morning of his admission and smoked crack cocaine the day before he was admitted. It starts during or after a long period of intravenous drug addiction with intermittent painless edema. 2022 Jun 24;13(4):457-465. doi: 10.4103/idoj.idoj_743_21. Unauthorized use of these marks is strictly prohibited. Puffy hand syndrome, apart from the chronic lymphedema treatment, has no specific medication available. Use Our 24 Hour text line. A 59-year-old man with a history of intravenous drug use (DU) presented with a 3-day history of right-hand swelling, redness, warmth and pain. National Library of Medicine 2009 Jan;38(1):153-5. doi: 10.1016/j.lpm.2008.04.009. FOIA Eplasty. 2013;2013:376060. doi: 10.1155/2013/376060. Before HHS Vulnerability Disclosure, Help and transmitted securely. Erythromelalgia was considered; however, she denied associated burning pain and fluctuation with temperature change classically described with this diagnosis. Eur J Dermatol. Ravaglia FF, Leite MG, Bracellos TF, Cliquet A Jr. ISRN Rheumatol. Vasa. World-class We Level Up CA Addiction Treatment Center providing Dual-Diagnosis Recovery Programs. Federal government websites often end in .gov or .mil. Quinine is well known to be toxic against veins and probably against lymphatic vessels. Careers. Infectious disease deemed the lesions to be inconsistent with vasculitis associated with endocarditis. Keywords: 8600 Rockville Pike 8600 Rockville Pike 8600 Rockville Pike The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). It typically presents with bilateral, non-pitting edema at the dorsum of the hands. Erythema and edema of the bilateral hands, Histologic findings of puffy hand syndrome. Rev Med Interne. WebAbstract Puffy hand syndrome develops after long-term intravenous drug addiction. Firstly described by Abeles in 1965 in New York prisoners, it could affect from 7 to 16% intravenous drug users. 2020;26(6):47. An official website of the United States government. This case presents an unusual opportunity to consider the differential diagnosis for erythematous, edematous hands, specifically during pregnancy in a patient with a history of IVDU. Narcotic addiction may induce systemic and local complications. HHS Vulnerability Disclosure, Help The urine drug screen was positive for benzodiazepines, tetrahydrocannabinol (THC), cocaine, and opiates. Lymphedema treatment currently consists of low-stretch bandaging and wearing elastic garments, which is effective in decreasing the volume of puffy hand syndrome. [Comorbid puffy hand syndrome and factitious disorders: an unusual association with poor prognosis]. Epub 2013 Oct 2. Federal government websites often end in .gov or .mil. It is characterized by a nonpitting edema, affecting the dorsal side of fingers and hands with Blood cell count revealed mild leukocytosis to 12.0 109/L. Careers. Mysteriously puffy hand: puffy hand syndrome. Observations: Barton M., Fett N. Red puffy hand syndrome mistaken for inflammatory arthritis. Edema in the right foot and left-hand edema displayed a punctate area around the mid-arch with associated tenderness to palpation without overlying redness, crepitus, or fluctuance. Cureus is not responsible for the scientific accuracy or reliability of data or conclusions published herein. WebSignificant IV drug use resulting in chronically puffy hands strongly supports a diagnosis of HCV infection. Internal Medicine, Medical College of Wisconsin, Wauwatosa, USA, 3 the contents by NLM or the National Institutes of Health. Diagnosis is based on the patient's history and clinical examination. Roux P, Villes V, Blanche J, Bry D, Spire B, Feroni I, Carrieri MP. To our knowledge, this is the second reported case of puffy hand syndrome initially presenting during pregnancy.4 One other case has been reported in a pregnant woman after 9years of intravenous cocaine use. Published by Elsevier Masson SAS. The above studies indicate that long-term compression therapy and the cessation of intravenous drug use can reduce puffiness after as little as three months. Additionally, we would like to thank all the treating healthcare personnel involved in patient care. FOIA Puffy hand syndrome revealed by a severe staphylococcal skin infection. WebVein Damage from IV Drug Use Dilated Veins: Dilated veins are sometimes called varicose veins and result from the vessel walls weakening. Alcohol Treatment Centers in California WebPuffy hand syndrome seen in intravenous drug addicts is poorly understood. WebWhen it comes to puffy-hand syndrome and drug abuse, repeated intravenous use or injection of drugs in or outside the veins destroys the lymphatics in the hands, preventing them from draining, which causes swelling. A large lump on the anterior aspect of his right arm was also noted, notably around sites of heroin injection. Local infectious complications such as cellulitis can be severe and frequently enable the diagnosis. Do not disregard or avoid professional medical advice due to content published within Cureus. sharing sensitive information, make sure youre on a federal Accessibility Observations 2.1. OCD Before Circulation. The patient was successfully treated with intravenous oxacillin and clindamycin. The site is secure. Histoplasma/Blastomyces urine antigens were negative. The pathophysiology of puffy hand syndrome is multifaceted but poorly understood [4]. Puffy hand syndrome is an uncommon clinical phenomenon associated with repeated intravenous drug abuse. The pathophysiology is believed to primarily be the result of lymphatic blockage from either direct toxicity of the injected drug, drainage of impurities, or infection complications. Before It is a chronic complication despite the cessation of drug use. Design and participants: The intravenous injection of narcotics, such as heroin, often triggers official website and that any information you provide is encrypted Please enable it to take advantage of the complete set of features! Epub 2008 Oct 14. -, Sanghavi M., Rutherford J.D. Clipboard, Search History, and several other advanced features are temporarily unavailable. Repeatedly injecting drugs into or outside the veins will destroy the lymphatic system in the hands, preventing proper drainage. Research shows that this condition is initiated by lymphatic obstruction. National Library of Medicine sharing sensitive information, make sure youre on a federal Cutaneous findings of puffy hand syndrome. It was associated with acrocyanosis (n = 1) or injection scars (n = 1). The examination showed diffuse swelling without joint inflammation. doi: 10.1002/14651858.CD003475.pub2. It typically presents with contour changes at the dorsum of the hands, which can extend proximally to the forearm [2]. Observations: Puffy hand syndrome seen in intravenous drug addicts is poorly understood. Federal government websites often end in .gov or .mil. Bookshelf Phone: (855) 695-1160 Owned & pperated by We Level Up California LLC an addiction dual diagnosis inpatient treatment center. The emergency solutions include cutting into a vein or finding it difficult to reach veins. Postambulatory hand swelling (big hand syndrome): prevalence, demographics, and association with dog walking. Injections in the hands and in the feet, and the absence of a tourniquet are significant risk factors for puffy hand syndrome. WebPuffy hand syndrome is a lesser-known complication of long-term intravenous DU and may affect about 7%16% of intravenous drug users.1 It may present after periods of The https:// ensures that you are connecting to the WebAbstract. It involves the This syndrome has to become more widely known because its management is mandatory, although symptomatic. Dean S.M. Puffy hand syndrome is a rare complication of intravenous drug addiction. 2017 Jan;84(1):83-85. doi: 10.1016/j.jbspin.2016.05.001. Although this syndrome primarily affects the hands, it can also impact the forearms. Although this condition may be more well-recognized in the addiction medicine and vascular surgery realms, it should also be recognized by dermatologists. She endorsed a 4-year history of injecting heroin, buprenorphine, suboxone, and morphine without tourniquet use into numerous areas from her chest to her toes, including both upper extremities. An official website of the United States government. WebPuffy Hand Syndrome. Simonnet N, Marcantoni N, Simonnet L, Griffon C, Chakfe N, Wertheimer J, Stephan D. J Mal Vasc. Barton M, Fett N. Hand edema and acrocyanosis: "puffy hand syndrome". An upper limb lymphoscintigraphy in one patient showed decreased radionuclide uptake of axillary lymph node and subdermal reflux tracer in the forearm. Punch biopsy demonstrated nonspecific findings of small vessel ectasia and minimal perivascular lymphocytes (Fig 2). A 40-year-old man and a 34-year-old woman, both intravenous drug users, with puffy hand syndrome were hospitalized for 11 days. Puffy hand syndrome due to drug addiction: a case-control study of the pathogenesis. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). He mentioned that the swelling began asymmetrically, bilaterally in the legs, and progressed to the right and left upper extremities. A 41-year-old man was admitted to the institution for bilateral feet, legs, arms, and hand edema with fever. -, Barton M., Fett N. Red puffy hand syndrome mistaken for inflammatory arthritis. Vasc Med. Thomasse Y, van Unen H, van Collenburg JJ, van Elburg RM. Lupus. Before Users themselves are often aware of the risk, particularly from hand injections, but most physicians, including Physical examination was Repeated injections into one area of and transmitted securely. Although it is supposed to be administered orally, many drug addicts use it as an i.v. Find Blue Cross Blue Shield Therapist Coverage for Substance Abuse. Puffy hand syndrome secondary to intravenous drug use presenting in pregnancy and persisting postpartum. WebPuffy hand syndrome seen in intravenous drug addicts is poorly understood. Injection practices are likely to cause puffy hands, warranting the necessity of educational campaigns directed toward patients who struggle with intravenous drug use. A 2020 study notes that a puffy hand is an uncommon clinical complication of IV drug use. Personality Disorder Puffy-hand syndrome affects 7% to 16% of Indeed, the patients suffering from puffy hand syndrome rarely consult for the edema due to the guilt feelings and despite the functional, aesthetic, and social disagreements. 2004 Oct;29(4):201-4. doi: 10.1016/s0398-0499(04)96748-0. Images in vascular medicine. FOIA alcoholic hepatitis 1999 Aug 28;143(35):1761-3. Bethesda, MD 20894, Web Policies PMC The cutaneous examination revealed erythema and edema of the dorsal side of her hands bilaterally with somewhat sharp demarcation at the wrist (Fig1). Puffy hand syndrome appears to be the end result of lymphatic obstruction. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). As a library, NLM provides access to scientific literature. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Additionally, articles published within Cureus should not be deemed a suitable substitute for the advice of a qualified health care professional. Urinalysis did not display proteinuria, and transaminases were within normal limits. 2020 Jun 15;26(6):13030/qt47d993kd. 2006 Sep;101(9):1347-51. doi: 10.1111/j.1360-0443.2006.01521.x. A 2/6 systolic murmur was appreciated throughout the precordium. Federal government websites often end in .gov or .mil. The intravenous injection of narcotics, such as heroin, often triggers complications. 2006 Oct;133(10):769-72. doi: 10.1016/s0151-9638(06)71040-7. The reasons could be as simple as not getting enough sleep or eating too much salt. It involves the hands and sometimes the forearms, and may cause functional, aesthetic and social disturbances when the hand volume is important. Therapeutic options for symptom relief tend to decrease the increased hydrostatic pressure within affected vessels. Local complications of pentazocine abuse: Case report and review. He reported routinely injecting heroin. The patient was ultimately diagnosed with puffy hand syndrome (PHS), an often overlooked complication of intravenous drug abuse affecting between 7% and 16% of addicts. A semi-synthetic opioid thats manufactured from the seeds of the opium poppy,opioid overdoses in general have increasedin, Heroin is a synthetic substance and opioid drug derived from the opium poppy plant. Hepatitis after intravenous injection of sublingual buprenorphine in acute hepatitis C carriers: report of two cases of disappearance of viral replication after acute hepatitis. Bookshelf 10175 Slater Ave, Suite 200 Fountain Valley, CA 92708, Prescription Drug Addiction Treatment Center, affects between 7% and 16% of intravenous drug users. Bethesda, MD 20894, Web Policies Joseph Gilmore has been in the addiction industry for three years with experience working for facilities all across the country. He saw his general practitioner for worsening edema with the erythema. Cefazolin was discontinued. Epub 2009 Feb 11. We Level Up California addiction rehab & detox center. The patient completed a course of ceftriaxone and a two-week course of amoxicillin/clavulanate, which yielded moderate improvement in the swelling. FOIA 8600 Rockville Pike Injection practices are likely to cause puffy hands syndrome, but buprenorphine misuse should not be considered as a significant risk factor. The site is secure. Puffy hand syndrome revealed by a severe staphylococcal skin infection. Amoxicillin and Alcohol Interactions. Peyrire H, Tatem L, Bories C, Pageaux GP, Blayac JP, Larrey D. Ann Pharmacother. Hepatitis C and injection drug use go hand in hand. Typically the puffiness was bilateral, the hands swollen from the proximal segments of the fingers to the wrist. This site needs JavaScript to work properly. Please enable it to take advantage of the complete set of features! 2022 May 29;14(5):e25453. Janardan A, Ayoub M, Khan H, Jha P, Dhariwal MS. Cureus. The authors have declared that no competing interests exist. government site. No imaging was performed. 2015 Apr 22;69:510-20. doi: 10.5604/17322693.1150215. If you need to stop intravenous drug use, we specialize in the outpatient treatment of substance use disorders. However, no signs of spongiosis on pathology made this less likely. Would you like email updates of new search results? [3] National Highway Traffic Safety Administration. After several months of evolution, the edema does not decrease, even with postural changes [3]. Clipboard, Search History, and several other advanced features are temporarily unavailable. The patient's concomitant chronic joint pain suggested a potential autoimmune etiology such as systemic lupus erythematosus, early edematous phase of scleroderma, or rheumatoid arthritis. 2009 May;30(5):460-4. doi: 10.1016/j.revmed.2008.11.011. WebThere is a syndrome, rarely observed in rheumatology, resulting in "puffy hands": the puffy hand syndrome. If you feel a traditional outpatient program (OP) doesnt offer you enough support or structure, we offer both intensive outpatient programs (IOPs) and partial hospitalization programs (PHPs). government site. Sex (women), injections in the hands and in the feet and the absence of tourniquet are significant risk factors for puffy hand syndrome . Clinically, puffy hand syndrome is particularly noted with edema of the hands and feet. Rev Med Interne. While medication-assisted treatment is invaluable, you will also attack the psychological side of drug addiction through counseling and psychotherapy. In addition, infectious complications such as cellulitis regularly support the diagnosis. This blockage prevents the lymph vessels from draining fluid in the body. Puffy hand syndrome is an uncommon byproduct of long-term intravenous drug use. At Renaissance Recovery our goal is to provide evidence-based treatment to as many individuals as possible. A woman in her 40's with remote intravenous drug use presented with over a decade of fixed, painless erythema and swelling of bilateral dorsal hands. Inclusion in an NLM database does not imply endorsement of, or agreement with, Epub 2016 Jun 3. and transmitted securely. WebHand Edema and Acrocyanosis: Puffy Hand Syndrome Pascal Del Giudice, MD Jacques Durant, MD Pierre Dellamonica, MD 2006;142 (8):1065-1086. doi:10.1001/archderm.142.8.1084 For 2 years, a 27-year-old woman had chronic swelling of both hands associated with recurrent cyanotic digital erythema. Dermatol Online J. Rev Med Interne. We Level Up CA Addiction Rehab Detox Dual Diagnosis Center This finding is noted in the pictures of our patients extremities. The diagnosis of puffy hand syndrome is an exclusion. Imaging findings of complications affecting the upper extremity in intravenous drug users: featured cases. Nous en rapportons deux cas. An official website of the United States government. Studieson heroin injection illustrate the drugs acidity has a damaging effect on vein health. One is the kind of drug being injected. The site is secure. No definitive diagnosis was made during this hospitalization. Unable to load your collection due to an error, Unable to load your delegates due to an error. This site needs JavaScript to work properly. He has been prescribed paracetamol and a nonsteroidal anti-inflammatory drug. National Library of Medicine Mysteriously Puffy Extremities: An Unintended Consequence of Intravenous Drug Abuse. Ann Dermatol Venereol. Before Chantalat L, Simon M, Fourgeaud C, Vignes S. Rev Med Interne. Del Giudice P, Durant J, Dellamonica P. "Puffy hand syndrome". sharing sensitive information, make sure youre on a federal IV drug useis a fast way to getdrugsinto the body. Alcohol withdrawal We hypothesized that injections of highdose sublingual buprenorphine, instead of the recommended sublingual administration, could play an important role in lymphatic obstruction and destruction. Puffy hand syndrome. Arch Dermatol 2006;142:10841085. However, intravenous drug users must still be warned of local and systemic complications of intravenous drug misuse. A curious cause of bilateral upper extremity lymphedema: puffy hand syndrome. Please enable it to take advantage of the complete set of features! After several months of evolution, the edema becomes permanent and does not decrease with the elevation of the upper limb. It is a chronic complication despite the cessation of drug use. MeSH Lake Elsinore, CA 92530 He had been reporting progressive feet and hands edema for several years, which became permanent for six months. PMC Pitting edema was noted in various locations. Andresz V, Marcantoni N, Binder F, Velten M, Alt M, Weber JC, Stephan D. Addiction. Unfortunately, this syndrome does not always go away. Post-Traumatic Stress Disorder 8600 Rockville Pike official website and that any information you provide is encrypted Buprenorphine may play an important role in the puffy hand sign. Clipboard, Search History, and several other advanced features are temporarily unavailable. 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