What Is Hot Tub Folliculitis?

In This Article

Hot tub folliculitis, or "hot tub rash," is a bacterial skin infection that emerges anywhere from a few hours to a few days after using an improperly maintained hot tub or swimming pool. The bacteria Pseudomonas aeruginosa (P. aeruginosa) infects hair follicles, particularly where swimwear meets the skin. This condition is also called Pseudomonas folliculitis.

Treatment for hot tub folliculitis ranges from home or over-the-counter remedies to prescription medications for severe cases, but common sense precautions can prevent infection.

Hot Tub Folliculitis Symptoms

A hot tub folliculitis rash is itchy, bumpy, and red. It resembles acne, however, the rash appears much more quickly.

When it first appears, hot tub folliculitis causes a profusion of small, grainy bumps called papules. These papules are bright to dark red.

As the rash progresses, the bumps become larger and more tender nodules that may be up to three centimeters in diameter. The papules have central pustules and 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.

Nipples of both men and women can be infected and become swollen and tender.

It's uncommon, but some people with hot tub folliculitis also feel unwell in general and may develop other symptoms such as:

  • Fever
  • Fatigue
  • Headache
  • Sore throat
  • Nausea
  • Swollen lymph nodes

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Hot tub folliculitis
Hot tub folliculitis. Joel Carillet / Getty Images

Causes

Hot tub folliculitis is caused by the bacterium Pseudomonas aeruginosa (P. aeruginosa), which infects the upper portion of hair follicles. This is the same microbe responsible for otitis externa, or swimmer's ear.

These bacteria thrive in warm water—particularly recreational water that is poorly maintained. The longer you soak in water tainted with Pseudomonas, the greater your chances of developing hot tub folliculitis.

Water can look clear and clean and still be harboring the Pseudomonas bacteria.

As the name suggests, hot tub folliculitis is most commonly acquired from hot tubs in which the chlorine or pH levels aren't properly maintained. However, there other potential sources:

  • Whirlpools and physiotherapy pools
  • Swimming pools, particularly those used by a large number of people
  • Warm lakes, rivers, or streams
  • Waterslides
  • Contaminated inflatable pool toys
  • Bath sponges

It can also result from wearing a wet bathing suit that wasn't thoroughly washed and dried prior to being worn or staying in a wet bathing suit for too long.

Other often overlooked causes of hot tub folliculitis are loofahs, nylon bath poufs, and other bath scrubbies that can harbor the Pseudomonas bacterium. Consider this possibility if you develop the rash but haven't been in a hot tub or pool, or if you're having recurrent cases.

Anyone can contract the hot tub folliculitis, but some people are more susceptible than others:

  • Those with a compromised immune system
  • People with eczema, dermatitis, or who have recently shave or waxed, all of which can compromise the skin's protective barrier
  • Young children, who tend to play in water for long periods of time, and older adults

The rash is not spread through personal contact with infected lesions.

Diagnosis

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 home remedies and your doctor's care don't clear up the rash, a skin sample may be taken to determine the cause. This can be done by taking a sample of fluid from the blisters or a small skin biopsy. The samples are examined under a microscope to look for Pseudomonas bacteria.

These tests may also be ordered if there is any doubt as to what is causing the rash. Hot tub folliculitis looks similar to other skin conditions such as:

Treatment

Pseudomonas aeruginosa cannot survive on healthy skin, so the rash usually resolves on its own after seven to 10 days.

Until then, several home remedies may help relieve symptoms and speed healing. Consult your doctor before trying any of these:

  • A warm, damp washcloth or compress applied to the infected area several times a day to relieve pain.
  • Over-the-counter anti-itch medicines, such as 1% hydrocortisone, can also help ease discomfort. Ask your doctor or pharmacist for recommendations.
  • Diluted white vinegar compresses are sometimes recommended, as acetic acid (the acid found in vinegar) has been shown to kill Pseudomonas. General guidelines call for half water, half vinegar mixture applied as a compress to the infected area for 15 minutes at a time, twice daily.

Since the rash is relatively benign and self-resolving, hot tub folliculitis doesn't usually require a specific treatment method.

If home care isn't doing the trick, or if your rash is severe, your doctor may prescribe a topical antimicrobial such as gentamicin cream or Polymyxin B spray.

In widespread, resistant cases, the oral antibiotic Cipro (ciprofloxacin) may be prescribed.

You should call your doctor if:

  • Your rash hasn't improved after 14 days.
  • Your rash gets increasingly painful or spreads.
  • You develop boils or large lumps.
  • Your breast tissue or nipples are painful.
  • You feel increasingly ill or have a fever.

A hot tub folliculitis rash may leave hyperpigmented (darkened) areas of skin after it has completely healed. This should fade over time, but it can take up to 18 months. If hyperpigmented skin bothers you, ask your doctor about treatments that can help fade discolored areas more quickly.

Prevention

Showering after coming in contact with contaminated water does not prevent infection, but there are a few things 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 as soon as possible. Sitting around in a wet suit raises the risk of developing the rash. Launder your swimwear, as well.
  • If you have a pool or hot tub, clean and chlorinate it regularly. Make sure that the water filtration system is continuously working. Frequently monitor disinfectant levels and change water as needed.
  • Learn how often public swim or bathing facilities are tested. Public pools, hot tubs, therapy pools, waterslides, or other recreational bathing areas are usually high-traffic and easily contaminated. The U.S. Centers for Disease Control and Prevention recommend water be tested at least twice daily.
  • Disinfect or change loofahs and bath poufs regularly. You can do this by soaking them in a diluted bleach and water mixture for 5 minutes and rinsing completely.

A Word From Verywell

Hot tub folliculitis usually is not a serious condition, though in some cases it can be severe and require treatment. It can cause embarrassment and anxiety for some because infected skin can be unsightly, though, so home remedies can help speed healing. The best weapon is prevention, which means knowing where you swim and how the facility is maintained, and changing and laundering your swimwear after bathing.

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Article Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Teraki Y, Nakamura K. Rubbing skin with nylon towels as a major cause of pseudomonas folliculitis in a Japanese population. J Dermatol. 2015 Jan;42(1):81-3. doi:10.1111/1346-8138.12712

  2. Nagoba BS, Selkar SP, Wadher BJ, Gandhi RC. Acetic acid treatment of pseudomonal wound infections--a review. J Infect Public Health. 2013 Dec;6(6):410-5. doi:10.1016/j.jiph.2013.05.005

  3. U.S. Centers for Disease Control and Prevention. Facts About Hot Tub Rash.

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