From the Guidelines
Hot tub folliculitis in children should be treated with oral ciprofloxacin (10-15 mg/kg twice daily for 7-10 days) for severe cases or when systemic therapy is required, as it offers an effective oral treatment option 1. For mild cases, keeping the affected areas clean with gentle soap and water is often sufficient, and the infection may resolve on its own within 7-10 days without specific medication. Some key points to consider in the management of hot tub folliculitis in children include:
- Over-the-counter pain relievers like acetaminophen (dosed by weight) can help alleviate uncomfortable symptoms.
- Topical antibiotics like silver sulfadiazine cream may be prescribed for localized infections.
- Prevention of recurrence is crucial, and this can be achieved by ensuring proper hot tub maintenance with adequate chlorination (2-4 ppm), regular pH testing (7.2-7.8), and filter cleaning.
- Children should shower with soap immediately after hot tub use to reduce the risk of infection.
- Those with open wounds or compromised immune systems should avoid hot tubs altogether, as they are more susceptible to infection. The infection is caused by Pseudomonas aeruginosa bacteria, which thrive in warm, moist environments and can enter hair follicles, causing the characteristic itchy, red rash that appears 1-4 days after exposure, primarily in areas covered by swimwear 1.
From the Research
Hot Tub Folliculitis in Children
- Hot tub folliculitis, also known as Pseudomonas folliculitis, is a rare adverse effect of using hot tubs, whirlpools, or swimming pools, characterized by painful, papulopustular skin lesions, often accompanied by low-grade fever, malaise, and other systemic symptoms 2.
- The condition can occur in children, as reported in a case of a 10-year-old boy who developed a widespread, nonpruritic, pustular rash after bathing in a hot tub 3.
- Pseudomonas aeruginosa is a common cause of folliculitis following contact with contaminated water, and can occur in children's pools filled with water from a well 4.
- The syndrome typically consists of a maculovesicular, often pruritic rash, and commonly occurring associated symptoms including fever, upper respiratory tract complaints, axillary adenopathy, and breast tenderness 5.
- Proper attention to hot tub chlorination and use are probably important in preventing this problem, and awareness of the syndrome by physicians may prevent unnecessary and costly diagnostic studies and treatment programs 5.
Prevention and Treatment
- Prompt recognition and treatment may shorten the duration of the disease and prevent further cases by identifying the source of exposure 2.
- Empirical treatment with erythromycin tablets has been reported to be effective in resolving the rash 3.
- Proper cleaning and maintenance of hot tubs can help prevent the occurrence of hot tub folliculitis 3.