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August 2006

Hand Edema and Acrocyanosis: “Puffy Hand Syndrome”

Arch Dermatol. 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. On examination, all fingers had stable swelling and erythema with a few superficial telangiectases (Figure 1 and Figure 2). An initial diagnosis of atypical Raynaud syndrome with edematous scleroderma was made. Her case was evaluated for systemic scleroderma with antinuclear antibody titer, ribonucleoprotein, antitopoisomerase, centromere, SSA, SSB, and Sm antibody titers, and the findings were negative. The rest of the clinical examination, which included the musculoskeletal, cardiac, digestive, and respiratory systems, was unremarkable. Findings from the examination were negative for human immunodeficiency virus but positive for hepatitis C virus. When these findings were presented to her, she revealed a history of drug addiction that involved injection of narcotic drugs in the dorsal aspect of both hands but that had ceased 3 years previously.