What are the other Names for this Condition? (Also known as/Synonyms)

• Pseudomonal Folliculitis
• Pseudomonas Aeruginosa Folliculitis
• Spa Pool Folliculitis

What is Hot Tub Folliculitis? (Definition/Background Information)

• Hot Tub Folliculitis is a bacterial skin infection that targets the orifice of the hair follicle (where the hair meets the skin). The infection occurs as the result of exposure to bacteria which can survive in warm water; especially hot tubs and water-based theme parks (that includes water slides and warm pools)
• Hot Tub Folliculitis is caused by the bacteria Pseudomonas aeruginosa that thrive in warm waters. The condition is more often observed in children, since they tend to spend more time in such waters than do adults
• The signs and symptoms of Hot Tub Folliculitis include the appearance of itchy or tender red skin papules that grow in size and can be filled with pus. Scratching the papules (bumps) can result in aggravation of the condition, prolong inflammation, cause abscess formation, and increase the healing time
• In most cases, Hot Tub Folliculitis is a self-limiting condition that will usually go away on its own within 7-10 days. Antibiotics and anti-itch medication may be administered, as needed, by the healthcare provider
• Preventative measures to reduce one’s risk for Hot Tub Folliculitis include minimizing use of community pools and water parks, as well as making sure that chlorination and water acidity levels are set to appropriate standards

Who gets Hot Tub Folliculitis? (Age and Sex Distribution)

• Hot Tub Folliculitis can affect individuals of all ages, though it is more common in children. This is probably because there is a tendency among them to stay longer in water than adults
• Both males and females can be affected
• All races and ethnic groups are known to be affected

What are the Risk Factors for Hot Tub Folliculitis? (Predisposing Factors)

The risk factors for Hot Tub Folliculitis include:

• Spending prolonged time in warm waters, especially those which are shared with other people, such as waterslides, hot tubs, and swimming pools (rarely)
• Individuals with poor immunity may have an elevated risk
• Not controlling chlorination and acid levels of community pools and water-based theme parks

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others. 

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Hot Tub Folliculitis? (Etiology)

• Hot Tub Folliculitis is caused by the bacterium Pseudomonas aeruginosa (non-pathogenic bacterial strain) found in warm waters such as hot tubs or water parks
• It is especially prevalent in hot tubs made of wood; people who use the same hot tub may present rashes

What are the Signs and Symptoms of Hot Tub Folliculitis?

The signs and symptoms of Hot Tub Folliculitis may include:

• Initial formation of skin rashes all over the body; symptom onset usually occurs anywhere from two hours to two days following exposure to warm waters
• Typical locations are the flanks, back, buttocks, and waistline
• The rash is bumpy, red, and itchy, and painful
• Over time the rash may:
  • Turn into nodules (swollen bumps) that are dark red, tender, and can fill with pus
  • Appear like acne
  • Become thicker in areas that were covered by the swimsuit
  • Lead to local scarring
• Sore throat, malaise, low-grade fever, and other systemic symptoms can be seen

In some, there may be severe itching and pain; scratching the itch may cause serious aggravation of the rashes, making it difficult to heal and prolonging healing times.

How is Hot Tub Folliculitis Diagnosed?

Hot Tub Folliculitis can closely resemble chicken pox; hence, it is important to visit a healthcare provider as soon as rashes develop, to rule out other skin conditions.

A diagnosis of Hot Tub Folliculitis is made by the following observations and tests:

• A careful physical examination and evaluation of the patient’s medical history
• Assessment of the presenting signs and symptoms
• Bacterial culture and sensitivity of skin lesions
• Dermoscopy: It is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
• Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
• Blood tests such as complete blood count (CBC) test

Generally, the condition can usually be diagnosed by the healthcare provider on examining the rashes, combined with a recent history of hot tub use or water-themed park visits.

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Hot Tub Folliculitis?

The possible complications of Hot Tub Folliculitis include:

• Severe discomfort where the rash occurs
• Formation of abscesses (buildup of pus in the rashes)
• The discoloration can last for months, even after the rashes go away, especially when the condition is aggravated by scratching
• Emotional stress from cosmetic concerns

How is Hot Tub Folliculitis Treated?

The treatment measures for Hot Tub Folliculitis may be as follows:

• Anti-itch medicine can help alleviate discomfort
• Topical antibiotics effective against Gram-negative organisms such as gentamycin 
• On some occasions, oral antibiotics directed against Pseudomonas may be used to treat the infection

How can Hot Tub Folliculitis be Prevented?

The prevention of Hot Tub Folliculitis may involve:

• Ensuring that hot tubs and water parks contain the proper chlorination and acidity prior to usage
• Avoiding warm waters that are repeatedly used by many people
• Avoid provoking the skin condition by scratching

What is the Prognosis of Hot Tub Folliculitis? (Outcomes/Resolutions)

The prognosis for Hot Tub Folliculitis is generally good as individuals often recover within 7-10 days after onset of symptoms.

• With itch-relief medication and/or antibiotics, the infection can be easily treated
• However, the rash can last for months if aggravated, such as by scratching

Additional and Relevant Useful Information for Hot Tub Folliculitis:

• There is no evidence to prove that oily foods and chocolate-based products have an influence on Hot Tub Folliculitis
• Cleaning the skin too hard with strong chemicals or soaps may aggravate the skin condition. Care must be taken avoid strong soaps and chemicals that could potentially worsen the condition
• The presence of dirt on the body is not a causative factor for Hot Tub. However, it helps to be clean and hygienic, which will help the condition from getting worse