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Hot tub folliculitis

Definition

Hot tub folliculitis is an infection of the hair follicles that occurs when you come into contact with certain bacteria that live in warm, wet areas.

Causes, incidence, and risk factors

Hot tub folliculitis is caused by the bacteria Pseudomonas aeruginosa. This form of bacteria survives in hot tubs, especially hot tubs made of wood, unless the water's acid and chlorine levels are strictly controlled.

Symptoms

Symptoms of hot tub folliculitis can be seen within several hours to 2 days after coming into contact with the bacteria.

  • It first appears as an itchy, bumpy, red rash.
  • Bumps may develop into dark red, tender nodules.
  • Bumps may become filled with pus.

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.

Those who shared the hot tub may have the same rash.

Signs and tests

Your health care provider can usually make this diagnosis based on a physical exam and knowing you have recently been in a hot tub. 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 acid levels and chlorine content of the hot tub may help to prevent hot tub folliculitis.

References

Habif TP. Bacterial infections. In: Habif TP, ed. Clinical Dermatology. 5th ed. St. Louis, Mo: Mosby Elsevier; 2009:chap 9.

Pasternack MS, Swartz MN. Cellulitis, necrotizing fasciitis, and subcutaneous tissue infections. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 90.


Review Date: 10/10/2010
Reviewed By: Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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