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What Is Hot Tub Folliculitis?

Hot tub folliculitis is a skin condition caused by bacteria found in improperly sanitized pools and hot tubs. It manifests as itchy, red bumps or pus-filled blisters. The culprit, Pseudomonas aeruginosa, thrives in warm, wet environments. Proper hygiene and water maintenance can prevent it. Curious about how to spot and treat this pesky rash? Dive deeper into our comprehensive guide.
Geisha A. Legazpi
Geisha A. Legazpi

Hot tub folliculitis or pseudomonas folliculitis is a skin infection that usually follows exposure to water contaminated with the organism Pseudomonas aeruginosa. Also called hot hand-foot syndrome, it affects hair follicles, leading to an inflamed condition called folliculitis. The entry of Pseudomonas may be through breaks in the skin, such as those caused by waxing, depilatory creams, and rigorous rubbing, or through hair follicles. This skin infection earned its name from the fact that hot water increases the risk of acquiring it. Although it can resolve on its own within 2 to 10 days, symptomatic treatment with acetic acid compresses may be needed for the itching.

This skin condition manifests as an erythematous or reddish rash with a pruritic or itchy quality. Initially appearing as macules or flat lesions less than 0.4 inch (1 cm) in diameter, they may evolve into papules, which are elevated lesions less than 0.4 inch (1 cm) in diameter, and pustules, which are papular lesions with pus. Rashes are particularly abundant in intertriginous areas or skin folds, such as those found in the axilla and groin. They are also abundant in areas of the skin covered by bathing suits.

Pseudomonas aeruginosa bacteria, which can cause hot tub folliculitis.
Pseudomonas aeruginosa bacteria, which can cause hot tub folliculitis.

The four major risk factors for hot tub folliculitis include tight-fitting bathing suits, crowding, frequent and prolonged exposure to contaminated water, and youth. Several environmental conditions are known to be present during hot tub folliculitis outbreaks. These include prolonged duration of water exposure, too many bathers in a bathing area, and inadequate sanitation. It has been also observed that many cases occur when there are inflatable pool toys, waterslides, and other water attractions present.

A hot tub.
A hot tub.

A history of hot tub exposure or other related exposure is a major clue to the diagnosis of hot tub folliculitis. To confirm the diagnosis, samples are taken from a pustule or from the suspected contaminated water. These samples are subjected to Gram staining and culture. Once they test positive for Pseudomonas aeruginosa, a causal relationship is established.

Hot tub folliculitis is considered a self-limiting disease because no treatment is needed for it to resolve. The rash is expected to go away 2 to 10 days after onset and the causative organism is not susceptible to the usual antibiotics, making the intake of these drugs ineffective and cost-inefficient. For people seeking relief of the symptoms, a compress made of 5% acetic acid may be used 2 to 4 times a day, for 20 minutes each time. This could ease the discomfort.

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    • Pseudomonas aeruginosa bacteria, which can cause hot tub folliculitis.
      By: Monika Wisniewska
      Pseudomonas aeruginosa bacteria, which can cause hot tub folliculitis.
    • A hot tub.
      By: Goran Bogicevic
      A hot tub.