puffy hand syndrome is an unrecognized complication of intravenous drug abuse this painless syndrome appears during or after a long period of drug addiction it involves the hands and sometimes the forearms and may cause functional aesthetic and social disturbances when the hand volume is important physiopathological mechanisms of the puffy hand syndrome are unclear and include venous and lymphatic insufficiencies infectious complications and direct toxicity of injected drugs and their adulterants low stretch bandage and elastic garment usually used in lymphedema treatment are proposed to treat the puffy hand syndrome.