What Is Hot Tub Folliculitis?

Hot tub folliculitis (Pseudomonas folliculitis), or "hot tub rash" is a bacterial skin condition that can be caused by using an improperly maintained hot tub or swimming pool. You may notice this red, itchy, and bumpy rash anywhere from a few hours to a few days later.

Hot tub folliculitis is caused by the bacteria Pseudomonas aeruginosa, which infects the hair follicles. This bacteria is commonly found in recreational water and natural sources of water, such as lakes and rivers.

Anyone can get hot tub folliculitis, but children tend to experience it more often than adults. Treatment may include home or over-the-counter remedies, or prescription medications. However, this rash often clears up on its own within 10 days.

This article covers the symptoms and causes of hot tub folliculits. It also discusses how it is diagnosed, treatment options, as well as prevention tips.

Hot Tub Folliculitis Symptoms

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

When it first appears, hot tub folliculitis causes small bumps called papules that are bright to dark red. As the rash progresses, the bumps become may become larger and may be up to three centimeters in diameter. They may also be filled with fluid, called pus, and form around hair follicles. However, they may also stay as small papules or superficial small pustules.

While the most common symptom is a rash, other symptoms may include:

• Swollen, infected nipples
• Feeling generally unwell
• Fever
• Fatigue
• Sore throat
• Headache
• Swollen lymph nodes
• Nausea

This photo contains content that some people may find graphic or disturbing.

See Photo

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.

Hot tub folliculitis is most commonly acquired from hot tubs in which the chlorine or pH levels aren't properly maintained. However, there are 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
• Wearing a wet bathing suit for too long or wearing one that wasn't thoroughly washed and dried
• Loofahs, nylon bath poufs, and bath scrubbers

Who Hot Tub Folliculitis Affects

Anyone can contract 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 shaved or waxed, all of which can compromise the skin's protective barrier
• Young children, who tend to play in the water for long periods of time, and older adults

Diagnosis

A healthcare provider should be able to diagnose hot tub folliculitis just by looking at it. Additional testing usually isn't necessary.

However, if home remedies and your healthcare provider'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.

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:

• Acne
• Contact dermatitis
• Other types of folliculitis
• Other types of bacterial infection, such as Staphylococcus aureus
• Insect bites
• Nodular scabies

Treatment for Hot Tub Folliculitis

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 healthcare provider before trying any of these:

• A warm, damp washcloth or compress applied to the infected area several times a day can relieve pain.
• Over-the-counter anti-itch medicines, such as 1% hydrocortisone, can also help ease discomfort. Ask your healthcare provider 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.

If home care isn't doing the trick, or if your rash is severe, your healthcare provider 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.

When to Contact Your Healthcare Provider

You should call your healthcare provider 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

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 after wearing it.
• 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. These should be tested at least two times per day.
• 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. The rash can cause embarrassment and anxiety for some, although home remedies may be able to help with the rash's appearance.

The best weapon is prevention, which means knowing where you swim and how the facility is maintained, as well as laundering your swimwear after use.