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.