Hot Tub Folliculitis Treatment and Prevention

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Hot tub folliculitis is a skin condition that emerges anywhere from a few hours to a few days after using an improperly maintained hot tub or swimming pool. Folliculitis is a rash due to inflammation of hair follicles and is typically caused by a bacterial or fungal infection.


Hot tub folliculitis is a bacterial infection of the hair follicles that are caused by the bacterium Pseudomonas aeruginosa. The rash is not spread through personal contact with infected lesions. These bacteria thrive in warm water—even in water that is sufficiently chlorinated.

P. aeruginosa bacteria is commonly found in whirlpools, hot tubs, water slides, physiotherapy pools, and even loofah sponges.

Children tend to be more at risk for contracting hot tub folliculitis, likely because they stay in the water longer. It can also occur from wearing a wet bathing suit that was not thoroughly washed and dried prior to use, or staying in a wet bathing suit for too long.

Symptoms and Appearance

Hot tub folliculitis is a rash that is itchy, bumpy, and red. It resembles acne.

It usually consists of several small, red papules or wheals that are a half-centimeter to 3 centimeters in diameter. The papules also have central pustules. Pus-filled blisters can also form around hair follicles.

The rash can erupt anywhere on the body that has come in contact with contaminated water. Lesions most often appear on parts of the body that have been exposed to wet clothing and swimsuits.

Diagnosis and Treatment

A doctor should be able to diagnose hot tub folliculitis just by looking at it and knowing that the patient has recently used a hot tub. Additional testing usually isn't necessary. However, if the typical treatment protocol doesn't clear up the rash, a skin sample may be taken to determine the cause.

Pseudomonas aeruginosa cannot survive on healthy skin, so the rash usually resolves on its own after seven to 10 days. The rash may leave hyperpigmented lesions that fade over time.

The rash typically responds well to home remedies, but you should consult your doctor before trying any at-home remedy. Apply a warm, damp washcloth or compress to the infected area several times a day. This will help relieve any pain and help the area drain. Over-the-counter anti-itch medicines can also help ease discomfort.

Since the rash is relatively benign and self-resolving, hot tub folliculitis doesn't usually require a specific treatment method. However, more severe cases can be treated with topical or systemic antibiotics.

Your doctor can prescribe topical treatments, such as Gentamicin cream and Polymyxin B spray. In widespread, resistant cases, the oral antibiotic Ciprofloxacin may be prescribed.


Showering after coming in contact with contaminated water does not prevent infection, but there are a few things that you can do to lower your risk of contracting hot tub folliculitis.

After using a hot tub or swimming pool, change out of your wet bathing suit and into clean, dry clothing.

Make sure that the hot tubs and swimming pools that you use are clean. If you have a pool or hot tub, clean and chlorinate it regularly. Make sure that the water filtration system is continuously working to eliminate dead skin. Frequently monitor disinfectant levels and change water as needed.

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