Hot tub folliculitis is a pruritic, pustular eruption confined to the hair follicle and secondary to a cutaneous infection with P aeruginosa. Patients have a history of hot tub, whirlpool, or swimming pool exposure within 24 to 72 hours of eruption. The lesions have a predilection for areas covered with bathing suits. Headache, sore throat, earache, and fever may accompany the pustules (but do not necessarily indicate systemic disease).
Pseudomonas hot-foot syndrome is related to hot tub folliculitis; patients report wading in a swimming pool (later discovered to have elevated P aeruginosa concentrations). The weight-bearing aspects of the soles have multiple 1- to 2-cm erythematous nodules. Unlike hot tub folliculitis, these lesions are exquisitely painful and not associated with other symptoms. Like hot tub folliculitis, the lesions resolve spontaneously without treatment.
Management and Disposition
The folliculitis usually involutes in 1 to 2 weeks without treatment; however, oral ciprofloxacin or topical gentamicin may decrease recovery time. In addition, the implicated source of exposure must be decontaminated to avoid reexposure. Patients with immunosuppression, widespread lesions, or concern for systemic involvement should be treated with oral ciprofloxacin.
Ensure the patient is aware of the cause and insist on decontamination of the water source.
Hot tub folliculitis may also result from contact with depilatory agents.
Hot Tub Folliculitis. Note the pustules localized to the hair follicles of the trunk and proximal extremity. (Photo contributor: Jeffrey S. Gibson, MD.)
Hot Tub Folliculitis. Folliculitis from Pseudomonas aeruginosa in a hot tub. (Photo contributor: Richard P. Usatine, MD. Used with permission. From Usatine RP, Smith MA, Mayeaux EJ, Chumley HS. The Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw Hill; 2013: Fig. 117-1.)