Generalized Exfoliative Dermatitis Associated with Co-Amoxiclav and Stage 2 Pressure Ulcer

Abstract

Generalized exfoliative dermatitis (GED), or erythroderma, is a severe inflammatory skin disorder characterized by diffuse erythema and scaling involving more than 90% of the body surface area. Drug hypersensitivity is a common cause of GED, while extensive skin barrier disruption and systemic physiological disturbances may increase susceptibility to pressure ulcer development. Early pressure ulcer development in GED, particularly without prolonged immobilization, remains insufficiently recognized. This case is clinically significant because the pressure ulcer developed despite the absence of prolonged immobilization, suggesting that severe skin barrier dysfunction and systemic physiological disturbances may contribute to reduced tissue tolerance and early pressure-related tissue injury. This case report aims to highlight the clinical presentation, diagnostic challenges, and therapeutic management of drug-induced GED complicated by an early-onset Stage 2 pressure ulcer and emphasize the importance of early pressure ulcer risk assessment. We reported a 43-year-old woman who developed generalized erythema and diffuse scaling two days after taking co-amoxiclav and was diagnosed with drug-induced GED. Dermoscopy showed a diffuse erythematous background with superficial white scaling. Laboratory evaluation revealed a hemoglobin level of 10.8 g/dL. No pressure ulcer was present at admission; however, a Stage 2 pressure ulcer developed in the gluteal region on the third day. Data were obtained through anamnesis, physical and dermatological examination, dermoscopic evaluation, laboratory investigations, clinical observation, treatment interventions, and follow-up during hospitalization at Adam Malik Hospital, Medan. The patient received intravenous methylprednisolone 62.5 mg/day and topical desoximetasone 0.25% combined with urea and salicylic acid twice daily. The pressure ulcer was treated with topical gentamicin 1% cream twice daily, repositioning, and pressure offloading. Significant clinical improvement was observed by the ninth day. This case highlights the potential for early pressure ulcer development in drug-induced GED  without prolonged immobilization, and underscores the importance of early risk assessment, pressure redistribution, repositioning, and preventive skin care.