Folliculitis is an inflammation of the hair follicles; a condition that can result from many different causes. The bumps, commonly called “hot tub itch”, occur shortly after spending time in a not-so-sanitary pool or hot tub, and are caused by the bacterium Pseudomonas aeruginosa.
The Ideal Opportunistic Pathogen
Pseudomonas aeruginosa is a ubiquitous Gram-negative species of bacteria. It is found just about everywhere – soil, water, man-made environments. This species is so widespread because of its versatility. It can exist at normal oxygen levels and also with very little access to oxygen (meaning that it is a facultative anaerobe). Pseudomonas is able to metabolize many different types of organic molecules. It is so adaptable and hardy that it can even grow in diesel and jet fuel!
The reason that everyone isn’t running around with a Pseudomonas infection has to do with individual differences in immune function. As an opportunist, Pseudomonas can usually only create an infection in people who have depressed immune function; those who are sick, run-down, have immune-related illnesses, the elderly and the very young.
Since Pseudomonas feels right at home in so many different environments, it also does just fine under conditions of inadequate chlorination of pools and hot tubs. In addition to preying on the immune compromised, those who swim in Pseudomonas-infested water are more likely to get folliculitis if they have cuts and scratches, and if the skin is especially dry or has been rubbed or scrubbed. Hot water, mildly alkaline pH (>7.8), and low chlorine level (
This condition cannot be transmitted from human to human. It can only be acquired from the environment.
Course of Pseudomonas Folliculitis
The rash can begin as soon as eight hours after exposure, or can take up to two weeks to emerge. However, it usually appears about 48 hours after contact with contaminated water.
The lesions start out as an itchy rash, with the affected follicles appearing pinkish and irritated. Over the course of infection, these bumps become pustules that eventually dry up. The rash usually clears on its own after 2-10 days.
Other symptoms and problems that may be associated with of Pseudomonas folliculitis include:* Flu-like symptoms of low-grade fever, headache and fatigue
* Ear infections
* Infection of the nipples
Pneumonia and urinary tract infection are also rarely associated with this type of folliculitis.
Treatment of Pseudomonas Folliculitis
Most cases of hot tub folliculitis resolve on their own, and don’t require medical intervention. Still, it never hurts to err on the side of caution. When in doubt, contact a medical professional to discuss the symptoms and determine if a trip to the doctor is necessary. If needed, the following treatments may help alleviate symptoms:* Soaking in an oatmeal bath.
* Vinegar compresses.
* Silver sulfadiazine cream (Silvadene).
* Cortisone, calamine or other anti-itch topical medications.
* Oral antibiotics, such as ciprofloxacin, are only required when infection is severe or the bacteria resistant.
For more information, see the eMedicine journal article on Pseudomonas folliculitis, or the Mayo Clinic’s folliculitis information.
Please note: The information in this article, which originally appeared in Suite101 online magazine, is not to be followed as medical advice, diagnosis or treatment. Please consult with your physician or primary health practitioner for information regarding your own personal health and necessary treatments.