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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 and wet areas.

Causes

Hot tub folliculitis is caused by Pseudomonas aeruginosa, a bacteria that survives in hot tubs, especially tubs made of wood. The bacteria can also be found in whirlpools and swimming pools.

Symptoms

The first symptom of hot tub folliculitis is an itchy, bumpy, and red rash. Symptoms can appear from several hours to 5 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 was in contact with the skin for longer

Other people who used the hot tub may have the same rash.

Exams and Tests

Your health care provider can often make this diagnosis based on looking at the rash and knowing that you have 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 provider may prescribe an antibiotic.

Outlook (Prognosis)

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

Possible Complications

In rare cases, a collection of pus (abscess) may form.

When to Contact a Medical Professional

Call your health care provider if you develop symptoms of hot tub folliculitis.

Prevention

Controlling the acid levels and chlorine, bromine, or ozone content of the hot tub may help prevent the problem.

References

D'Agata E. Pseudomonas aeruginosa and other Pseudomonas species. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, Updated Edition. 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 221.

James WD, Berger TG, Elston DM. Bacterial infections. In: James WD, Berger TG, Elston DM, eds. Andrews' Diseases of the Skin: Clinical Dermatology. 12th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 14.

Review Date: 10/14/2018

Reviewed By: Michael Lehrer, MD, Clinical Associate Professor, Department of Dermatology, University of Pennsylvania Medical Center, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., a business unit of Ebix, Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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