Saturday, December 03, 2005


Hot Tub Folliculitis

Hot Tub Folliculitis

From Heather Brannon, MD,Your Guide to Skin Conditions / Acne.

Folliculitis is inflammation of the hair follicle caused by infection, chemical irritation, or physical injury. There are several different types of folliculitis, but a common type is called "hot tub" folliculitis, or pseudomonas folliculitis.

Hot Tub Folliculitis Cause

Hot tub folliculitis is an infection of the hair follicles caused by the bacteria Pseudomonas aeruginosa. This bacteria is commonly found in contaminated whirlpools, hot tubs, water slides, physiotherapy pools, or even loofah sponges. Children tend to get hot tub folliculitis more often, probably because they stay in the water longer. The rash is not spread by personal contact with infected lesions.

Hot Tub Folliculitis

RashThe rash of hot tub folliculitis consists of several small .5 - 3 cm red papules or wheals with a central pustule.

The rash can erupt anywhere on the body that has been in contact with the contaminated water. Areas that are in contact with wet clothing tend to have more lesions. The rash usually resolves on its own in 7 to 10 days leaving a hyperpigmented lesion that resolves over months. Some people experience fatigue in the first few days of the rash, but fever is uncommon.

Picture of folliculitis on the leg

Hot Tub Folliculitis TreatmentMost cases of hot tub folliculitis resolve on their own and don't require specific treatment. If needed the following treatments may be effective:

Vinegar compresses applied for 20 minutes two to four times a day
Silver sulfadiazine cream (Silvadene) applied two times a day
Oral antibiotics such as ciprofloxacin are only needed in widespread or resistant cases

Hot Tub Folliculitis Prevention

Showering after contact with contaminated water does not prevent infection. The following measures should be considered when maintaining facilities that may be prone to water contamination:

Continuous water filtration to eliminate dead skin
Frequent monitoring of disinfectant levels
Frequent changing of water


Hot tub folliculitis

Folliculitis is a superficial infection of the hair follicle. Hot tub folliculitis is a folliculitis that develops after exposure to certain forms of bacteria that reside in warm, wet environments such as hot tubs.

Causes, incidence, and risk factors

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 hot tubs made of wood, 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 bumps, some of which may be filled with pus. It may then develop into dark red tender nodules. The rash may be more dense under swimsuit areas, where the material has held the contaminated water in contact with the skin for a longer period of time.


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
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 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. It may recur if the infected hot tub is not cleaned.


abscess formation (rare)

Calling your health care provider

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


Careful attention to controlling the pH and chlorine content of the hot tub may help to prevent hot tub folliculitis.

Update Date: 1/11/2003


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