This image displays follicular elevations of the skin and small pus-filled lesions. This image displays a pseudomonas infection in the skin pores. In pseudomonas folliculitis (hot tub folliculitis), the red skin lesions are often quite large, as displayed in this image. This image displays a close-up of the typical red bumps of pseudomonas folliculitis (hot tub folliculitis). This image displays the red areas typical of pseudomonas folliculitis (hot tub folliculitis).  This image displays a severe case of pseudomonas folliculitis (hot tub folliculitis).  Hot tub folliculitis occurs on skin that was covered by one's bathing suit after being in a hot tub or jacuzzi. The spots often go away after several days, without any treatment. This image shows spots in a person who was in a hot tub 4 days prior. <br />
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Hot Tub Rash (Pseudomonas Folliculitis)  Information for adults

Picture of Hot Tub Rash (<i>Pseudomonas</i> Folliculitis): This image displays follicular elevations of the skin and small pus-filled lesions. Divider line
This image displays follicular elevations of the skin and small pus-filled lesions.
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Overview
Hot tub rash (Pseudomonas folliculitis) is an infection of the hair follicle with Pseudomonas bacteria. It is most commonly seen in people who bathe in a contaminated spa, swimming pool, or hot tub.

Hot tub rash is usually resolved without treatment within 2 weeks.
Who's At Risk
Hot tub rash can occur in people of any age, of any race, and of either sex.

Individuals with hot tub rash usually have a history of one of the following:
  • Bathing in a contaminated spa, swimming pool, or hot tub
  • Using a contaminated loofah sponge
  • Wearing a contaminated diving suit
Signs and Symptoms
The most common locations for hot tub rash include:
  • Groin and buttocks ("bathing suit" distribution)
  • Abdomen or lower back
  • Armpits
  • Chest or upper back
  • Upper arms
  • Upper legs
The rash appears as small (2–10 mm) pink to red bumps, which may be filled with pus or covered with a scab. Located around hair follicles, these bumps tend to be itchy or tender.

Hot tub rash typically arises within 1–4 days of exposure to the contaminated source. In addition to the rash, symptoms can include mild fever, headache, sore throat, and fatigue. Swollen and tender lymph nodes (glands that help produce antibodies, special proteins that fight off infection) may occur. Breast tenderness occasionally develops in both men and women, as glands in the nipple may become infected.

Although hot tub rash usually resolves within 7–14 days without treatment, the rash may leave behind patches of darker (hyperpigmented) skin. These patches are more pronounced in darker-skinned people and may take months to return to normal pigmentation.
Self-Care Guidelines
In order to prevent hot tub rash, proper maintenance and chlorination of pools, spas, and hot tubs is essential. Sponges and loofahs should be completely dried between uses in order to kill any bacteria.

If the rash is itchy, an over-the-counter antihistamine may be helpful.
When to Seek Medical Care
Make an appointment with your doctor if you develop an itchy or tender rash, especially if it is associated with fever, swollen lymph nodes, or breast tenderness.
Treatments Your Physician May Prescribe
Your doctor may wish to obtain a bacterial culture of one of the pus-filled bumps in order to establish the diagnosis.

No special therapy is required, typically. However, in severe cases, your physician may recommend the following:
  • Acetic acid compresses
  • An oral antibiotic, such as ciprofloxacin
  • Topical antibiotic cream, such as gentamicin

References

Bolognia, Jean L., ed. Dermatology, pp.1132. New York: Mosby, 2003.

Freedberg, Irwin M., ed. Fitzpatrick's Dermatology in General Medicine. 6th ed, pp.1860-1861, 1901-1902. New York: McGraw-Hill, 2003.
Last Updated: 22 Dec 2008