Paudel Vikash, Chudal Deepa
National Medical College, Birgunj, Parsa, Nepal.
Nepal Police Hospital, Kathmandu, Nepal.
Case Rep Dermatol Med. 2020 Nov 6;2020:8845759. doi: 10.1155/2020/8845759. eCollection 2020.
Toxic epidermal necrolysis is a life-threatening dermatological emergency with high mortality if not treated in time. Here we report a case of toxic epidermal necrolysis due to carbamazepine in rural Nepal in COVID-19 pandemic who was successfully treated with the help of mobile teledermatology. The clinical impression of toxic epidermal necrolysis was made from "WhatsApp" video calls using a smart phone. The supportive features were the history of starting of carbamazepine 2 weeks prior for seizure disorder, clinical findings in serial photographs of skin with 40 percent body surface area involvement of necrotic skin lesions and bulla, and involvement of oral mucosa and eyes. The patient was immediately asked to stop carbamazepine and was treated with intravenous fluids and systemic steroids along with symptomatic management. As the whole world was suffering from lockdown due to COVID-19 crisis, it was impossible for the rural area patient to visit a dermatologist. Thus, with the help of paramedics staff in a community health center and mobile teledermatology, the patient was diagnosed as carbamazepine-induced toxic epidermal necrolysis and treated successfully with good outcome.
中毒性表皮坏死松解症是一种危及生命的皮肤科急症，若不及时治疗，死亡率很高。在此，我们报告一例在新冠疫情期间尼泊尔农村地区因卡马西平引起的中毒性表皮坏死松解症病例，该病例在移动远程皮肤病学的帮助下成功治愈。中毒性表皮坏死松解症的临床诊断是通过使用智能手机进行的 “WhatsApp” 视频通话得出的。支持性特征包括：患者在发病前2周因癫痫障碍开始服用卡马西平；皮肤连续照片的临床发现显示，坏死性皮肤病变和水疱累及体表面积的40%，以及口腔黏膜和眼睛受累。患者立即被要求停用卡马西平，并接受静脉输液、全身用类固醇治疗以及对症处理。由于全球因新冠危机而处于封锁状态，农村地区的患者无法前往看皮肤科医生。因此，在社区卫生中心护理人员和移动远程皮肤病学的帮助下，该患者被诊断为卡马西平引起的中毒性表皮坏死松解症，并成功治愈，预后良好。
