BACKGROUND: Puffy hand syndrome is a complication of intravenous drug abuse, 
which has no current available treatment. Arm and forearm edema are voluminous 
and cause functional and aesthetic disturbances. We report two cases 
successfully treated by low-stretch bandages.
OBSERVATIONS: A 40-year-old man and a 34-year-old woman, both intravenous drug 
users, with puffy hand syndrome were hospitalized for 11 days. Treatment 
included daily multilayer bandaging. 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. 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. The patients were taught 
self-bandaging techniques during their hospital stays. Elastic gloves were 
fitted at the end of treatment. Reduction of lymphedema volume remained stable 
after 18 months in one patient while for the second patient further treatment 
and hospitalization were required due to poor compliance.
DISCUSSION: The pathogenesis of this edema is probably multifactorial: venous, 
lymphatic insufficiency and the direct toxicity of injected drugs. Lymphedema 
treatment currently consists of low-stretch bandaging and wearing elastic 
garments, which is effective in decreasing the volume of puffy hand syndrome.