From the Guidelines
Hot tub folliculitis, caused by Pseudomonas aeruginosa, is typically self-limiting and resolves within 7-10 days without specific antibiotic treatment, but for more severe cases, oral antibiotics like ciprofloxacin 500mg twice daily for 7-10 days may be prescribed. The diagnosis of hot tub folliculitis is based on the presence of itchy, red rash with small pustules, typically appearing 1-4 days after exposure to contaminated water.
Key Considerations
- The infection develops when Pseudomonas bacteria enter hair follicles, particularly in the warm, moist environment of inadequately chlorinated hot tubs and pools 1.
- For mild cases, treatment involves self-care measures including stopping hot tub use, gently washing the affected areas with antibacterial soap, applying warm compresses, and taking over-the-counter pain relievers like acetaminophen or ibuprofen as needed.
- According to the 2018 WSES/SIS-E consensus conference, folliculitis may be treated by antibiotics or drainage alone, but necrotizing skin and soft-tissue infections require surgical intervention including drainage and debridement of necrotic tissue in addition to antibiotic therapy 1.
Prevention and Management
- To prevent recurrence, ensure hot tubs are properly maintained with adequate chlorine levels (2-4 ppm), regularly clean and replace filters, shower before and after hot tub use, and avoid prolonged soaking, especially if you have open wounds or compromised immunity.
- For more severe or persistent infections, a healthcare provider may prescribe topical antibiotics like silver sulfadiazine cream or oral antibiotics such as ciprofloxacin 500mg twice daily for 7-10 days, as fluoroquinolone agents offer an oral treatment option that may be preferred over parenteral nonfluoroquinolone antimicrobial therapy 1.
From the Research
Diagnosis of Pseudomonas Folliculitis
- The diagnosis of Pseudomonas folliculitis requires a thorough knowledge of the symptoms, which include a pruritic skin eruption involving areas abundant with apocrine glands such as the axillae, breasts, and pubic area 2.
- Patients usually develop itching, pain, and redness of the eyes and ears 2.
- A detailed history focusing on the patient's recent use of hot tubs, spas, or swimming pools is essential for diagnosis 2.
- The eruption typically consists of pruritic papules, papulopustules, nodules, and urticarial lesions on the trunk and extremities, developing 8 to 48 hours after exposure in a contaminated facility 3.
Treatment of Pseudomonas Folliculitis
- Treatment is not usually necessary because the infection is most often self-limited and benign 2, 4.
- The infection usually resolves spontaneously within 7 to 10 days 3, 4.
- However, systemic therapy may be indicated in patients with widespread lesions, systemic symptoms, or in immunosuppressed patients 5.
- In some cases, treatment with antibiotics such as ciprofloxacin may be effective 5.
Prevention of Pseudomonas Folliculitis
- Proper maintenance of equipment, including chlorination and pH monitoring, is necessary to prevent the recurrence of Pseudomonas folliculitis 2, 3.
- Attention to water conditions is the best way to prevent this irritating skin condition 4.
- Awareness of the syndrome by physicians may prevent unnecessary and costly diagnostic studies and treatment programs 6.