Early high-dose corticosteroid treatment on carbamazepine-induced toxic epidermal necrolysis: A case report

Introduction: Toxic Epidermal Necrolysis (TEN) is a severe and life-threatening allergic reaction. Although there is ongoing debate, some guidelines suggest that early administration of high-dose systemic corticosteroids may be beneficial. 

Case Illustration: A 42-year-old man was hospitalized with painful, multiple erythematous patches that initially appeared in the chest area and then spread to the entire head, hands, and legs. On the third day, the lesions had spread and developed into blisters in multiple areas. The patient had a known history of food allergies to eggs and chicken, as well as a history of stroke, with ongoing therapy for the past eight years. However, about a week ago, the patient was introduced to a new medication, Carbamazepine. Before the skin lesions appeared, the patient had been consuming the drug for 5 days. After diagnosing with TEN, treatment plan included intravenous methylprednisolone 500 mg/24 hours for 3 days, followed by tapering off, diltiazem 100 mg b.i.d., calcitriol 0.5 mg o.d., and a combination of topical therapy, including dexamethasone 0.25%, vaseline album, mupirocin 2%, triamcinolone acetate, and momethasone furoate. After the thirteenth day of treatment, the patient's entire skin had peeled off, and only hypopigmented patches remained. The patient was discharged and sent home, and a follow-up was carried out a month later and was able to carry out his normal daily activities.

Conclusion: Comprehensive management, starting with drug withdrawal, supportive therapy, adequate wound medication, and early administration of high-dose systemic steroids, can be a life-saving and low-cost therapy in resource-constrained settings.