What is the treatment for dermatitis (inflammation of the skin) caused by using a hot tub?

Treatment for Hot Tub Dermatitis

The primary treatment for hot tub dermatitis is complete avoidance of the contaminated hot tub, which is paramount for resolution of symptoms, along with supportive care including topical corticosteroids for inflammation and appropriate antimicrobial therapy if secondary infection is present. 1

Types of Hot Tub Dermatitis

Hot tub exposure can cause several types of skin inflammation:

1. Hypersensitivity pneumonitis ("hot tub lung") - primarily a respiratory condition caused by Mycobacterium avium complex (MAC) 1
2. Pseudomonas folliculitis - bacterial infection presenting as pruritic papules, papulopustules, and nodules 2
3. Contact dermatitis - reaction to chemicals like potassium peroxymonosulfate (shock treatment) 3
4. Exacerbation of existing skin conditions - such as atopic dermatitis or eczema herpeticum 4

Treatment Algorithm

Step 1: Immediate Measures

• Complete avoidance of the contaminated hot tub - This is the most critical intervention 1
• Cleanse affected areas with mild soap and warm water 5
• Apply moisturizers to repair the skin barrier 6

Step 2: Anti-inflammatory Treatment

• Apply low to medium-potency topical corticosteroids (such as hydrocortisone) to affected areas 3-4 times daily 6, 5
  • For mild to moderate inflammation: hydrocortisone 1% cream
  • For more severe inflammation: consider medium-potency preparations for short-term use (2-4 weeks)
  • Avoid long-term use of high-potency corticosteroids, especially on the face 6

Step 3: Management of Secondary Infections

• If bacterial infection is suspected (increasing redness, warmth, pain, purulent drainage):
  • Obtain bacterial cultures 6
  • Consider appropriate antibiotics based on culture results 6
• If viral infection is suspected (vesicular lesions, especially in patients with atopic dermatitis):
  • Consider antiviral therapy (acyclovir) for suspected eczema herpeticum 6, 4

Step 4: Symptomatic Relief

• For severe pruritus: Cool compresses may provide relief 6
• For extensive inflammation: Consider wet-wrap therapy with topical corticosteroids for 3-5 days 6

Special Considerations

For Severe Cases

• If more than 20% of body surface area is affected, systemic corticosteroids may be considered for short-term use 6
• For persistent cases not responding to topical treatments, referral to a dermatologist for consideration of other therapies may be warranted 7, 8

Prevention

1. Proper hot tub maintenance - Following manufacturer's recommendations for cleaning and disinfection 1
2. Bathing before hot tub use - This reduces contamination 1
3. Avoidance of indoor hot tubs for those with documented hypersensitivity pneumonitis 1

Pitfalls and Caveats

• Do not continue hot tub use during treatment - this will worsen symptoms 1
• Avoid long-term use of topical antibiotics due to risk of resistance and skin sensitization 6
• Do not use antihistamines as primary treatment for the dermatitis - they are not effective for treating the underlying condition 8
• Be aware that patients with atopic dermatitis are at higher risk for complications like eczema herpeticum when exposed to hot tubs 4
• Remember that complete resolution may take 7-10 days even with appropriate treatment 2

The prognosis for hot tub dermatitis is generally good with appropriate avoidance of the source and supportive care. Most cases resolve within 1-2 weeks without scarring if properly managed 1, 2.