Folliculitis, Pseudomonas (Hot Tub Folliculitis)

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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

Trusted Links

MedlinePlus: Bacterial Infections
MedlinePlus: Hair Diseases and Hair Loss

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.