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Hot tub folliculitis

Hot tub folliculitis is an infection of the skin around the lower part of the hair shaft (hair follicles). It 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 tubs made of wood. Controlling the acid and chlorine level in the water can limit the growth of the bacteria.

Symptoms

The first symptom of hot tub folliculitis is an itchy, bumpy, red rash. Symptoms can appear from several hours to 2 days after contact with the bacteria.

The rash may:

  • Turn into dark red, tender nodules
  • Have bumps that fill with pus
  • Look like acne
  • Be thicker under swimsuit areas where the water has been in contact with the skin longer

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

Signs and tests

Your health care provider can often make this diagnosis based on looking at the rash and knowing that you've been in a hot tub.  Testing is usually not needed.

Treatment

Treatment may not be needed. The mild form of the disease often clears on its own. Anti-itch medicines may be used to ease discomfort.

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

Expectations (prognosis)

This condition usually clears without scarring. The problem may come back if you use the hot tub again before it has been 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

Controlling the acid levels and chlorine content of the hot tub may help prevent the problem.

References

James WD, Berger TG, Elston DM, eds. Andrews' Diseases of the Skin: Clinical Dermatology. 11th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 14.

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.

Updated: 11/20/2012

Kevin Berman, MD, PhD, Atlanta Center for Dermatologic Disease, Atlanta, GA. Review provided by VeriMed Healthcare Network. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, David R. Eltz, Stephanie Slon, and Nissi Wang.


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