Orofacial and digital frostbite caused by inhalant abuse

Inhalation of volatile substances is a cheap and accessible way for individuals, most commonly teenagers, to ingest mind-altering substances. The adverse effects of using inhalants, including cardiac dysrhythmia, respiratory tract injury, and asphyxiation, can be devastating. Detection often is difficult, but a high degree of suspicion with patterns of perioral, perinasal, and/or digital lesions can help identify use. We report an uncommon case of severe orofacial and digital frostbite initially mistaken for an allergic reaction in a 20-year-old man following intentional inhalation of a commercial air-dusting agent containing 1,1,1,2-tetrafluoroethane (HFC-134a).