This study is the first description of puffy skin disease (PSD) causing economic losses in cultured rainbow trout in Turkey. The disease occurred in different sized fish (70-250 g) reared in raceways at 13 degrees C water temperature in the Mediterranean area of Turkey in April 2018. Clinically affected fish were inappetent and lethargic. Diseased fish showed focal lateral skin lesions that appeared as cutaneous swellings with pale grey patches on the flank. In addition, excessive mucus production, raised scales or areas of scale loss and petechial hemorrhages were present in affected fish. In severe cases epidermal hyperplasia was observed in the skin. Infiltration of dendritic melanocytes was commonly observed in the epidermis. Scale pockets were frequently enlarged and filled with pale eosinophilic fluid and myositis was associated with the presence of muscle necrosis in affected fish. Mortality rate was low. Prevalence of affected fish in one farm was assessed as approximately 10% in April 2018. No bacteria were isolated from the affected fish.