By Gary M. White, MD
Hot tub folliculitis--as the name suggests--is a folliculitis that occurs soon after using a hot tub. It is caused by the bacteria Pseudomonas. Pseudomonas folliculitis may also occur in patients who use a washcloth, loofah, or some type of sponge in the shower or bath. If such an item stays wet between uses, the Pseudomonas can contaminate the item and produce a chronic source of infection of the skin. An outbreak of 35 people who used the same swimming pool was linked to contamination of inflatables by Pseudomonas.
The typical patient with hot tub folliculitis develops multiple pustules atop urticarial bases scattered on the trunk or buttocks several days after using a hot tub contaminated by Pseudomonas. One typical feature is the significant inflammation surrounding the pustule. Often, the surrounding erythema is 1-2 cm in diameter--larger than that usually seen with Staphylococcal folliculitis. The distribution is typically symmetric and truncal, with a preference for the flanks.
Some patients may have a chronic infection, e.g., over many months. This condition is almost invariably associated with repeated exposure to a source. For example, one child suffered from repeated folliculitis of the buttocks from sitting on a bath mat that harbored Pseudomonas. Another child played almost every day in standing water that was the source of exposure.
No treatment is needed, as the disease is self-limited. Persistence may rarely occur in very sweaty individuals. If treatment is desired, oral ciprofloxacin 500 BID may be given.
The hot tub or spa should be more aggressively maintained with adequate chlorinating and pH level checks. If a sponge or wash rag is the cause, it should be disposed of.
Courtesy Michael O. Murphy, MD
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