The authors report an original clinical presentation of factitious disorders of 
the upper extremity in an ex-drug-addict patient with puffy hand syndrome. 
Chronic self-inflicted ulcerations appeared with sequential manner. The patient 
confessed deliberate self-harm and transfer of anxiety on his hands, the aspect 
of which had become intolerable. Association of puffy hand syndrome with 
comorbid psychosis and major depression explained immediate recurrence of 
ulcerations despite fitted medication and long-term psychotherapy.