Adverse drug reactions (ADRs) can lead to severe consequences and increased morbidity and mortality rates. Phenobarbital is one of the most common anti-epileptic drugs that has numerous adverse drug reactions, including toxic epidermal necrolysis. The event is rare and a medical emergency. A six year-old female epileptic child with phenobarbital induced toxic epidermal necrolysis referred for the management of diffuse exfoliative lesions involving her eyes and buccal mucosa. Associated with the skin lesions, the patient reported high grade fever, reddish eye discoloration, dysphagia and dry cough. The exfoliative skin lesion involved ninety percent of her total body surface area. The patient was managed with withdrawal of phenobarbital, IV antibiotics, systemic corticosteroid, twice daily wound care, analgesic and nutritional support. Early recognition, discontinuation of offending medications, and prompt intervention are crucial to mitigate harm. Raising awareness about ADRs and their management is vital for enhancing patient safety and outcomes.