Hot tub folliculitis refers to an inflammation of the hair follicles due to an infection with Pseudomonas aeruginosa, a tough bacterium that is quite resistant to chlorinated swimming pool water. You can contract an infection with this culprit in, among other things, hot tubs and swimming pools with water that has not been sufficiently disinfected. Treatment is not always necessary. A mild form of the disease often resolves spontaneously. Anti-itch medicines can be used to relieve pain, itching and irritation. In severe cases, the doctor may prescribe an antibiotic. The prognosis is favorable. Sometimes complications arise, such as a secondary infection if you scratch the spots.
- What is hot tub folliculitis?
- Hot tub folliculitis symptoms
- Small, red itchy bumps on the skin
- Alarm symptoms
- Hot tub folliculitis cause and contagious
- Risk factors
- Examination and diagnosis
- Physical examination
- Differential diagnosis
- Hot tub folliculitis treatment
- Antibiotics
- Soothe itching
- Prognosis
- Complications
- Prevention of hot tub folliculitis
Folliculitis / Source: James Heilman, MD, Wikimedia Commons (CC BY-SA-3.0)
What is hot tub folliculitis?
Hot tub folliculitis, also known as ‘hot tub folliculitis’ and also known as ‘pseudomonas folliculitis’, is a skin condition that develops within a few hours to a few days after bathing in hot water, for example in a hot tub, spa pool, jacuzzi or swimming pool with water that has not been sufficiently disinfected. This involves inflammation of the hair follicles due to infection with the bacterium Pseudomonas aeruginosa . These culprits settle in the hair follicles and cause an inflammatory reaction on the spot. Symptoms may appear within 8 hours to 5 days after exposure. Not all exposed persons develop hot tub folliculitis. Unlike many other bacteria, the pseudomonas bacterium is reasonably resistant to chlorinated swimming pool water. Small skin lesions facilitate contamination with the bacteria.
Hot tub folliculitis symptoms
Small, red itchy bumps on the skin
After becoming infected with this bacterium, you will develop a very itchy folliculitis over the entire skin within a few hours to days after bathing, but especially on the parts of the skin covered with swimwear. Hot tub folliculitis is characterized by an eruption of small red itchy bumps on the skin that develop into pimples. Some people with hot tub folliculitis feel unwell and develop earache, sore throat, nausea and vomiting, headache and/or low-grade fever. Hot tub folliculitisis rarely develops into a more serious infection (ecthyma gangrenosum). People with a weak immune system, for example those taking immunosuppressive medications, are at greater risk.
Alarm symptoms
It is important to consult a doctor immediately if you experience the following symptoms:
- skin that is red, warm, swollen or extremely painful
- fever above 38°C
- spreading or recurring folliculitis
Jacuzzi / Source: TChapman9, Wikimedia Commons (CC BY-2.0)
Hot tub folliculitis cause and contagious
Hot tub folliculitis is due to an opportunistic bacterial infection of the skin with the bacterium Pseudomonas aeruginosa. It thrives in warm water and is even reasonably resistant to chlorinated swimming pool water. Contamination occurs more often if the water is not disinfected sufficiently. The culprit may also be transmitted via contaminated bath sponges. Skin damage, such as scratches and wounds, means that infection can occur more quickly.
Risk factors
Anyone can potentially contract hot tub folliculitis when your skin is exposed to the culprit, but some people are more at risk for a bacterial skin infection or its complications, including:
- (young) children because they often spend longer in the water
- people who already have acne or eczema, which makes it easier for the infection to penetrate the skin (the inflamed and damaged skin serves as a portal of entry for the bacteria)
- people who spend long periods of time in hot and poorly chlorinated water
- people who often use hot tubs
- people who have recently shaved, waxed or epilated
- persons with a weakened immune system due to conditions such as leukemia, HIV or diabetes
Examination and diagnosis
Physical examination
The diagnosis is normally made immediately by the doctor. The picture is often very clear to a doctor. A skin biopsy (the removal of a piece of tissue for microscopic examination) is therefore generally not necessary.
Clown eczema / Source: James Heilman, MD, Wikimedia Commons (CC BY-SA-4.0)
Differential diagnosis
Hot tub folliculitis can closely resemble other skin conditions, such as:
- Acne vulgaris;
- Acneiform eruptions;
- Cutaneous candidiasis (fungal infection of the skin);
- Dermatological manifestations of coccidioidomycosis (a fungal disease caused by the fungus Coccidiodes immitis);
- Miliaria or heat rash;
- Erythema toxicum neonatorum;
- Fox-Fordyce disease;
- Graham-Little-Piccardi-Lasseur Syndrome;
- Impetigo or impetigo;
- Insect bites;
- Irritating contact dermatitis;
- Milia or barley grains;
- Papular urticaria;
- Perioral dermatitis (clown dermatitis);
- Itchy papular eruption due to HIV infection;
- Rosacea;
- Seabather’s eruption;
- Subcorneal pustular dermatosis, Sneddon-Wilkinson disease (subcorneal pustular dermatosis).
Hot tub folliculitis treatment
Healing normally occurs spontaneously, often within a few days. This is because the skin is not in fact a favorable place for the Pseudomonas bacteria to live. Treatment is therefore often not necessary.
Antibiotics
In very extensive forms or when the skin lesions do not disappear quickly enough, treatment with antibiotics can be considered. The bacteria have now proven resistant to most local antibiotics.
Soothe itching
The itching is the worst part of hot tub folliculitis. If you are looking for relief from itching, you may want to consider the following self-care measures:
- Avoid scratching. While it may give you immediate relief, it will usually make the itching worse and leave you vulnerable to further and long-term infection. This can also lead to scarring.
Cloudy apple cider vinegar / Source: Veganbaking.net, Wikimedia Commons (CC BY-SA-2.0)
- Do not shave the infected area. The hair follicles may be infected, but shaving the hair does not help. In fact, it will only worsen the condition.
- If the rash is on your scalp or beard, use a shampoo that contains selenium or propylene glycol. It won’t get rid of the rash, but it may provide some relief.
- Prepare a warm compress with a clean washcloth soaked in warm water, white vinegar, or apple cider vinegar. Press the washcloth with the solution against the rash for ten minutes, three to six times a day. Make sure you use a clean washcloth every time.
Prognosis
This condition usually resolves without scarring. The problem can return if you use the hot tub again before it has been cleaned.
Complications
Persistent discomfort and the formation of an abscess are rare. If you scratch the rash, it is possible that this will cause a secondary infection or scarring.
Prevention of hot tub folliculitis
The best way to prevent hot tub folliculitis is to only use hot tubs that you know have been regularly and thoroughly cleaned and sanitized. This means that the hot tub’s acid and chlorine levels must be monitored and maintained and that the water filters must be working properly. Because hot tubs have much warmer water than swimming pools, the chlorine breaks down more quickly, meaning they require more thorough treatment.
If your skin comes into contact with the bacteria, it is not always possible to prevent an infection no matter how quickly you act afterwards. However, there are some precautions you can take to reduce the risk, including:
- Avoid shaving or removing hair before using a hot tub. Waxing should be done at least a day or so in advance if possible.
- Do not sit in a damp swimsuit. Shower immediately after leaving the bath and wash with soap and water.
- Clean your swimsuit thoroughly after soaking in a warm bath. If you don’t, you could reinfect yourself at a later date.
- If you are concerned, you can ask the lifeguard how often the hot tub is maintained. Water that is checked twice a day is usually safe.
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