The puffy hand of narcotic addiction has been described. Based on biopsies of skin and subcutaneous tissue, venograms and lymphangiograms, the pathogenesis has been shown to be destruction of the lymphatics leading to fibrotic replacement of the subcutaneous tissue. The importance of this finding as an aid in the detection of the addict has been noted. It has been emphasized that the puffy hand must be differentiated from the palmar fascial space infections with dorsal edema.