Hot Tub Folliculitis is also known as Spa Pool Folliculitis and Pseudomonas aeruginosa Folliculitis. It is characterized by pruritic follicular, maculopapular, vesicular, or pustular lesions occurring within 1-4 days after bathing in a hot tub, whirlpool, or public swimming pool that is untreated. As water temperature rises, free chlorine levels fall allowing bacteria to proliferate. Diving suits may become colonized and wearing them may result in Pseudomonas folliculitis.
Most lesions occur on the sides of the trunk, axillae, buttocks and proximal extremities. The areola of the breasts and axillary regions are frequently involved. Associated symptoms may include earache, sore throat, headache, fever and malaise. Rarely systemic infection may result in a breast abscess and bacteremia. Large public outbreaks have occurred in public pools.
ETIOLOGY: The cause is Pseudomonas aeruginosa.
CLINICAL COURSE: The folliculitis usually resolves in 7-14 days without any treatment, although prolonged episodes have been reported. In patients with fever and constitutional symptoms or prolonged disease a third-generation cephalosporin or a fluoroquinolone such as ciprofloxacin or ofloxacin may be helpful. Preventive measures are directed at preventing contamination through; water filtration, automatic chlorination or manual measures to maintain water pH values between 7.2-7.8, with frequent water changes. Bromination of the water and ozone ionization are other options that are available. To read more about Hot Tub Folliculitis click HERE and HERE.