Hot tub folliculitis

Hot tub folliculitis is caused by Pseudomonas aeruginosa, a bacteria that survives in hot tubs, especially tubs made of wood.

The first symptom of hot tub folliculitis is an itchy, bumpy, and red rash. Symptoms can appear from several hours to 2 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.

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 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.

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

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

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

Controlling the acid levels and chlorine content of the hot tub may help prevent the problem.

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.

Lacuesta MPM, Phelps RG. Folliculitis. In: Lebwohl MG, Heymann WR, Berth-Jones J, Coulson I, eds. Treatment of Skin Disease: Comprehensive Therapeutic Strategies. 4th ed. Philadelphia, PA: Elsevier; 2014:chap 83.

Updated by: David L. Swanson, MD, Vice Chair of Medical Dermatology, Associate Professor of Dermatology, Mayo Medical School, Scottsdale, AZ. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.