A patient presents with psychotic symptoms and a perioral rash. Which substance is most likely responsible?

A patient presents with psychotic symptoms and a perioral rash. Which substance is most likely responsible?

• A. Inhalants
• B. Alcohol
• C. Cocaine
• D. Opioids

Answer: (A)

Inhalants can produce both neuropsychiatric effects and skin irritation around the mouth from sniffing solvents. Repeated sniffs of volatile substances (glues, paints, solvents) often irritate the perioral skin, leading to a characteristic rash, while the CNS effects can include euphoria, dizziness, impaired judgment, and, with heavier use or withdrawal, psychotic symptoms such as hallucinations or delusions. The presence of a perioral rash together with psychosis is a classic clue pointing to inhalant exposure. Cocaine can cause psychosis but doesn’t typically cause a perioral dermatitis. Alcohol can cause psychosis in withdrawal but again isn’t associated with this perioral skin finding. Opioids cause sedation and miosis rather than a perioral rash.

Inhalants can produce both neuropsychiatric effects and skin irritation around the mouth from sniffing solvents. Repeated sniffs of volatile substances (glues, paints, solvents) often irritate the perioral skin, leading to a characteristic rash, while the CNS effects can include euphoria, dizziness, impaired judgment, and, with heavier use or withdrawal, psychotic symptoms such as hallucinations or delusions. The presence of a perioral rash together with psychosis is a classic clue pointing to inhalant exposure.

Cocaine can cause psychosis but doesn’t typically cause a perioral dermatitis. Alcohol can cause psychosis in withdrawal but again isn’t associated with this perioral skin finding. Opioids cause sedation and miosis rather than a perioral rash.