Hot tub folliculitis is a skin infection of the hair follicles that appears after coming into contact with bacteria contaminated water. The infection is caused by the bacteria Pseudomonas aeruginosa which lives in wet, warm areas including hot tubs, whirlpools, and waterslides. Children tend to be affected more often than adults.

The infection can begin a few hours to days after being exposed to contaminated water. It begins as an eruption of itchy, red bumps that are seen primarily on the trunk. The bumps often develop into more tender nodules and can sometimes fill with pus. In areas occluded by bathing suits, the rash can be more severe, and women who wear one-piece suits are more susceptible to infection. Systemic symptoms rarely occur but can include fever, malaise and fatigue.

Hot tub folliculitis typically resolves without any treatment within 5-10 days. Topical treatments that can be helpful include silver sulfadiazine cream twice a day or white vinegar applied to the rash for 20 minutes two to four times per day. Oral antibiotics can be used for 5-10 days if the rash is severe or resistant to topical treatment. It is important to note that although the rash may resolve within 5-10 days, it can leave behind reddish-brown, hyperpigmented areas that can take a few months to completely disappear.

Inadequate care of water, prolonged water exposure and an excess number of people in the pool can all predispose one to infection. Continuous water filtration, adequate chlorine levels, and changing the water frequently can all decrease the risk of infection. Unfortunately, showering after being exposed to contaminated water does not decrease the rate of infection so it is best to avoid exposure.

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