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Hair follicle anatomy
Hair follicle anatomy

Hot tub folliculitis
Definition:
Folliculitis is a superficial infection of the hair follicle. Hot tub folliculitis is a folliculitis that develops after exposure in a hot tub.

Causes, incidence, and risk factors:
Most folliculitis is caused by the common organism Staphylococcus aureus. Hot tub folliculitis is different in that it is caused by Pseudomonas aeruginosa. Pseudomonas survives in hot tubs, especially the wood type, unless the pH and chlorine content are strictly controlled.

Hot tub folliculitis becomes noticeable within half a day to two days after exposure. It first appears as itchy (pruritic) bumps -- some pus filled -- and may develop into dark red tender nodules. The rash may be denser 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 last three days
  • itchy, bumpy, red rash appearing within 2 days of hot tub exposure
  • bumps may develop into dark red tender nodules
  • may develop 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. Oral or topical anti-pruritics ("anti-itch" medications) may be used.

In severe cases, your physician may prescribe an oral antibiotic such as ciprofloxacin.
Expectations (prognosis):

This condition usually clears without scarring, but 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 suspect a diagnosis 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: 8/7/2001
Reviewed By: Michael Lehrer, M.D., Department of Dermatology, University of Pennsylvania Medical Center, Philadelphia, PA. Review provided by VeriMed Healthcare Network.
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