From the Guidelines
Hot tub folliculitis should be treated with self-care measures for mild cases, and oral ciprofloxacin 500mg twice daily for 7-10 days for severe or persistent cases, as supported by the use of systemic fluoroquinolones in the treatment of skin infections caused by Pseudomonas aeruginosa 1. Hot tub folliculitis is a skin infection caused by the bacteria Pseudomonas aeruginosa that develops after exposure to contaminated water in hot tubs, whirlpools, or swimming pools.
- Key characteristics of hot tub folliculitis include:
- Itchy, red bumps or pustules typically appearing 1-4 days after exposure
- Most commonly occurring on areas covered by swimwear where bacteria can become trapped against the skin
- Caused by Pseudomonas aeruginosa, which can thrive in inadequately chlorinated water For mild cases, treatment involves:
- Stopping hot tub use
- Gently washing affected areas with antibacterial soap
- Applying warm compresses
- Taking over-the-counter pain relievers like acetaminophen or ibuprofen as needed Most infections resolve on their own within 7-10 days without antibiotics. However, for severe or persistent cases, a healthcare provider may prescribe:
- Topical antibiotics like polymyxin B
- Oral ciprofloxacin, as it offers an oral treatment option that may be preferred over parenteral nonfluoroquinolone antimicrobial therapy for children who require systemic therapy 1. To prevent hot tub folliculitis, it is essential to:
- Ensure proper hot tub maintenance with adequate chlorination (2-4 ppm) or bromine (4-6 ppm) levels
- Shower before and after hot tub use
- Limit time spent in the water By following these guidelines and using oral ciprofloxacin for severe cases, as supported by the evidence 1, individuals can effectively manage and prevent hot tub folliculitis.
From the Research
Hot Tub Folliculitis Overview
- Hot tub folliculitis is a rare, adverse effect of the therapeutic or recreational use of hot tubs, whirlpools, and occasionally swimming pools, caused by Pseudomonas aeruginosa 2.
- The condition is characterized by painful, papulopustular skin lesions often accompanied by low-grade fever, malaise, and other systemic symptoms 2.
- It can also present as a maculovesicular, often pruritic rash, with associated symptoms including fever, upper respiratory tract complaints, axillary adenopathy, and breast tenderness 3.
Symptoms and Diagnosis
- Symptoms of hot tub folliculitis typically appear several hours or days after hot tub exposure 3.
- The rash is often concentrated in the swimsuit area, with fewer widely scattered lesions on the trunk and extremities 4.
- Diagnosis is typically made based on clinical presentation and history of hot tub exposure, although laboratory tests and cultures may be performed to confirm the presence of Pseudomonas aeruginosa 2, 4.
Treatment and Prevention
- Hot tub folliculitis may resolve spontaneously without treatment, but prompt recognition and treatment may shorten the duration of the disease and prevent further cases 2, 3.
- Proper attention to hot tub chlorination and use are probably important in preventing this problem 3.
- Empirical treatment with antibiotics, such as erythromycin, may be effective in resolving the rash 4.
- A systematic review of treatments for bacterial folliculitis and boils found that comparative trials have not identified important differences in efficacy or safety outcomes between different oral antibiotics 5.