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Hot tub folliculitis

Definition

Hot tub folliculitis is an infection of the hair follicles that results from exposure to certain bacteria that live in warm, wet areas.

Causes, incidence, and risk factors

Most folliculitis is caused by the common organism Staphylococcus aureus. However, hot tub folliculitis is caused by Pseudomonas aeruginosa. Pseudomonas survives in hot tubs, especially hot tubs made of wood, unless the water's acid and chlorine levels are strictly controlled.

Hot tub folliculitis can be seen within several hours to 2 days of exposure. It first appears as itchy bumps, some of which may be filled with pus. It may then develop into dark red tender nodules. The rash may be thicker under swimsuit areas, where the material has held the contaminated water in contact with the skin for a longer period of time.

Symptoms

• History of using hot tub within previous 3 days
• Itchy, bumpy, red rash appearing within 2 days of hot tub exposure
• Bumps developing into dark red tender nodules
• Bumps developing small pustules (pus-filled blisters)
• Multiple members of family or party with same rash and same hot tub exposure

Signs and tests

Physical examination combined with a history of recent hot tub use are sufficient for your health care provider to make this diagnosis. Testing is usually unnecessary.

Treatment

Treatment may not be needed, as the mild form of the disease usually clears on its own. Anti-itch medications may be used.

In severe cases, your health care provider may prescribe an antibiotic such as ciprofloxacin.

Expectations (prognosis)

This condition usually clears without scarring. It may recur if the infected hot tub is not cleaned.

Complications

• Abscess formation (rare)
• Discomfort

Calling your health care provider

Call your health care provider if you develop symptoms of hot tub folliculitis.

Prevention

Careful attention to controlling the pH and chlorine content of the hot tub may help to prevent hot tub folliculitis.

Review Date:10/23/2006
Reviewed By:Kevin Berman, MD, PhD, Associate, Atlanta Center for Dermatologic Disease, Atlanta, GA. Review provided by VeriMed Healthcare Network.

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