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Hot tub folliculitis

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Hot tub folliculitis
Other names: Pseudomonas aeruginosa folliculitis; hot tub rash;[1] spa pool folliculitis[2]
Extensive involvement of the abdominal skin by hot tub folliculitis
SpecialtyDermatology
SymptomsItchy red rash that develops into small blisters at the hair follicles[1]
ComplicationsCellulitis, scarring[2]
Usual onsetWithin a couple of days of exposure[1]
CausesPseudomonas aeruginosa[2]
Risk factorsHot tubs[2]
Diagnostic methodBased on the symptoms in the setting of an exposure[2]
Differential diagnosisOther types of folliculitis, eosinophilic pustular folliculitis, miliaria, sea bather's eruption[2]
PreventionWashing with soap and water after being exposed; proper maintenance of hot tubs[1]
TreatmentNone; steroid cream; ciprofloxacin[3]
PrognosisGenerally resolves after a few days[1]
FrequencyRelatively common[4]

Hot tub folliculitis, also known as pseudomonal folliculitis, is a type of inflammation of hair follicles.[5] Symptoms include an itchy red rash that develops into small blisters at the hair follicles.[1] Onset is generally a couple of days after being exposed; though may occur as early as 8 hours.[1][2] Areas under the swimsuit are often more affected.[1] Other symptoms may include a burning sensation, enlarged lymph nodes, fever, or vomiting.[2] Complications may include cellulitis and scarring.[2]

It is caused by a bacterial infection of hair follicles by Pseudomonas aeruginosa.[2] This bacteria is commonly found in hot tubs and spas; though may also occur in swimming pool or bathtubs.[2] Longer time in the water increases the risk of being affected.[2] Diagnosis is generally based on the symptoms in the setting of an appropriate exposure.[2] Occationally cultures may be done to support the diagnosis.[6]

Prevention is by washing with soap and water after potentially being exposed and proper maintenance of hot tubs.[1] Normally, specific treatment is not required and the rash will go away on its own.[3][6] Occasionally steroid creams or ciprofloxacin by mouth may be used.[3] Generally it resolves after a few days;[1] though may last up to two weeks.[2]

Hot tub folliculitis is relatively common.[4] It can occur as an outbreak.[6] Children are more commonly affect as they typically stay in the water longer than adults.[7] The condition was first described in 1975, following an outbreak related to a hot tube.[8][9]

Signs and symptoms

Hot tub folliculitis can be painful or itchy, and left alone without scratching will go away much more quickly. If the rash is aggravated, it can stay, worsen, and spread, lasting for months. By that time, it is much more difficult to treat. In an immunocompetent person, the rash is self-limited and will usually resolve after about 7 to 10 days but the condition can leave a hyperpigmented lesion that goes away after a few months.

  • Pseudomonas folliculitis

    Pseudomonas folliculitis

  • Close up of hot tube folliculitis

    Close up of hot tube folliculitis

See also

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9 "Preventing Hot Tub Rash". Healthy Swimming. 8 May 2024. Archived from the original on 26 August 2024. Retrieved 20 September 2024.
  2. ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 2.12 2.13 "Spa pool, jacuzzi, hot tub, pseudomonas folliculitis". DermNet®. 26 October 2023. Archived from the original on 20 September 2024. Retrieved 21 September 2024.
  3. ↑ 3.0 3.1 3.2 Goodheart, Herbert P. (2010). Goodheart's same-site differential diagnosis : a rapid method of diagnosing and treating common skin diseases. Philadelphia, Pa.: Lippincott Williams & Wilkins. p. 296. ISBN 978-1605477466.
  4. ↑ 4.0 4.1 "Acne-like breakouts could be folliculitis". www.aad.org. Archived from the original on 24 September 2024. Retrieved 21 September 2024.
  5. ↑ James, William D.; Elston, Dirk; Treat, James R.; Rosenbach, Misha A.; Neuhaus, Isaac (2020). "14. Bacterial infections". Andrews' Diseases of the Skin: Clinical Dermatology (13th ed.). Edinburgh: Elsevier. p. 270. ISBN 978-0-323-54753-6. Archived from the original on 2023-06-30. Retrieved 2023-06-01.
  6. ↑ 6.0 6.1 6.2 Jacob, JS; Tschen, J (23 September 2020). "Hot Tub-Associated Pseudomonas Folliculitis: A Case Report and Review of Host Risk Factors". Cureus. 12 (9): e10623. doi:10.7759/cureus.10623. PMID 33123436.
  7. ↑ Harris-Ray, Nicklya. "What Is Hot Tub Folliculitis in Children?". WebMD. Archived from the original on 1 June 2023. Retrieved 21 September 2024.
  8. ↑ "Pseudomonas Folliculitis: Background, Pathophysiology, Etiology". Medscape. 26 June 2021. Archived from the original on 27 June 2024. Retrieved 21 September 2024.
  9. ↑ Water-related Disease Outbreaks Surveillance. U.S. Department of Health and Human Services, Public Health Service. 1983. p. 13. Archived from the original on 24 September 2024. Retrieved 21 September 2024.
Classification

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