The Dermatologic Perils of Swimming: Hot Tub Folliculitis

Hot Tub Folliculitis

An 11-year-old boy presented for evaluation of an itchy rash that developed during a ski vacation. He mentioned that he had enjoyed a hot tub during his trip.

The itchy rash is hot tub folliculitis—a superficial infection of the hair follicle caused by Pseudomonas aeruginosa, usually serotype 0:11. The bacteria can be found in hot tubs, whirlpools, or swimming pools. Hot water, aeration, and turbulence encourage growth of the organism. Patients may note the onset of the rash within 6 hours or up to several days after exposure. The rash is a pruritic pustular or papular eruption that is most intense in areas covered by a bathing suit. Occasionally, erythematous or violaceous nodules are present. Fever, lymphadenopathy, and malaise occur in a small number of cases. The rash resolves spontaneously in 1 to 2 weeks and only rarely requires treatment with topical or oral antipseudomonal medication.

Adequate bacterial surveillance and maintenance of hot tubs, whirlpools, and swimming pools are key, although avoidance of affected pools or tubs is the best prevention. Pools and tubs suspected of harboring P aeruginosa should be cultured and sterilized when results are positive. Immunocompromised persons are susceptible to the more serious complications of folliculitis (eg, cellulitis) and should avoid hot tubs entirely.

See also:

Seabather's Eruption
Swimmer's Itch