What is hot tub folliculitis: a common childhood infection

When hair fol­li­cles on the body become inflamed due to injury, infec­tion, or irri­ta­tion, it is called fol­li­culi­tis. Fol­li­culi­tis can be rec­og­nized by swollen, painful areas on the neck, face, chest, and but­tocks. There is a spe­cial form called hot tub fol­li­culi­tis that is espe­cial­ly con­ta­gious and irri­tat­ing. Most often, this dis­ease devel­ops in chil­dren. Such fol­li­culi­tis is caused by bac­te­ria and occurs after con­tact with con­t­a­m­i­nat­ed water.

What is hot tub folliculitis?

Hot tub fol­li­culi­tis is a pseudomonas infec­tion of the skin sur­round­ing hair fol­li­cles. Symp­toms appear after con­tact with water con­tain­ing Pseudomonas aerug­i­nosa bac­te­ria. Pseudomonas is found in warm, humid places such as swim­ming pools and water parks, hot tubs and water slides. The bac­te­ria enter through hair fol­li­cles or skin abra­sions.

If con­t­a­m­i­nat­ed water is left on the skin for a long peri­od of time, it can cause a fol­lic­u­lar rash. The rash usu­al­ly appears about a few days after a vis­it to a water park or hot tub. It can also appear a few days after swim­ming in a lake, pond, or out­door pool that is rarely cleaned.

Chil­dren are more affect­ed than adults, although any­one can get fol­li­culi­tis from con­tact with the bac­te­ria. Oth­er groups more like­ly to devel­op are immuno­com­pro­mised peo­ple, those who already have der­mati­tis or acne, or peo­ple who have recent­ly waxed or shaved.

Symptoms of folliculitis

A skin reac­tion may devel­op sev­er­al days, rarely hours after con­tact with con­t­a­m­i­nat­ed water. It can all start with itchy bumps on the tor­so. Some­times these bumps turn into nod­ules and may con­tain pus. Areas cov­ered by bathing suits may devel­op a more severe rash. Peo­ple who wear one-piece swim­suits are more sus­cep­ti­ble to infec­tion.

Here are the most com­mon symp­toms of hot tub fol­li­culi­tis, although symp­toms may vary from child to child:

• Irri­tat­ed, red hair fol­li­cles.
• Red itchy bumpy rash.
• Dam­aged hair.
• Pus in hair fol­li­cles.

In mild cas­es, the rash may go away on its own in a few days. How­ev­er, sys­temic con­di­tions such as malaise, fever, and fatigue can some­times occur.

What can be confused with pseudomonas folliculitis?

• Insect bites some­times look like fol­li­culi­tis. The dif­fer­ence can be deter­mined by the fact that the bites are very itchy and appear on open areas of the skin, and fol­li­culi­tis affects parts of the body that were under a bathing suit or next to abra­sions more. To find out, read our guide to insect bites.
• Some microbes con­sid­ered Gram-pos­i­tive can also cause oth­er forms of fol­li­culi­tis. Oth­er Gram-pos­i­tive organ­isms cause sim­i­lar skin man­i­fes­ta­tions in ado­les­cents who shave their legs, in chil­dren with dia­per rash and oth­er con­di­tions that irri­tate the trunk and but­tocks.
• Sim­i­lar symp­toms may be caused by sen­si­tiv­i­ty to cer­tain drugs (sodi­um bro­mide), gram-neg­a­tive or oth­er fol­li­culi­tis, or be a man­i­fes­ta­tion of acne (pim­ples).

hot tub folliculitis prevention

Improp­er water care, pro­longed expo­sure to water, and too many peo­ple in the pool can put a child at greater risk of infec­tion. Fre­quent replace­ment of stand­ing water, ade­quate lev­els of chlo­rine, and con­stant water fil­tra­tion can reduce the risk of infection—so watch where your child bathes.

After swim­ming, teach chil­dren to take off their swim­suit or swim­ming trunks (they will need to be washed and dried) and show­er with soap. Tak­ing a show­er after swim­ming flush­es chlo­rine from the skin and reduces the lev­el of infec­tion with bac­te­ria — but not if the child has scratch­es and abra­sions on the body. With skin injuries, it is bet­ter not to climb into sus­pi­cious reser­voirs and pools.

How is folliculitis diagnosed and treated?

The diag­no­sis of fol­li­culi­tis can be made by a doc­tor based on a phys­i­cal exam­i­na­tion and his­to­ry tak­ing. When exam­in­ing sores, the doc­tor may take a skin cul­ture, a sam­ple of wound dis­charge, which will be sent to a lab­o­ra­to­ry to iden­ti­fy the bac­te­ria. After a diag­no­sis of fol­li­culi­tis is made, the doc­tor will pre­scribe the opti­mal treat­ment.

The ill­ness usu­al­ly goes away in about a week. How­ev­er, there are sev­er­al fac­tors that deter­mine the dura­tion of the pathol­o­gy and the choice of ther­a­py for chil­dren:

• Child’s age.
• Health sta­tus.
• How wide­spread and inflamed is the rash.
• Tol­er­ance to drugs and ther­a­py.

Treat­ments used may include:

• Warm com­press for drainage.
• Local solu­tions of antibi­otics.
• Oral or intra­venous antibi­otics.
• Drainage of ulcers.

The spe­cial­ist may also pre­scribe top­i­cal solu­tions such as sil­ver sul­fa­di­azine applied twice dai­ly.

Even if the rash dis­ap­pears after a few days, it may leave a hyper­pig­ment­ed red-brown area. This area may dis­ap­pear com­plete­ly only after a few months.

Are there other types of folliculitis?

There are sev­er­al oth­er types of fol­li­culi­tis that need to be ruled out when mak­ing a diag­no­sis.

• Bac­te­r­i­al fol­li­culi­tis: This is a very com­mon type, usu­al­ly with white, pus-filled, itchy bumps. Usu­al­ly caused by Staphy­lo­coc­cus aureus, which is con­stant­ly present on the skin.
• Pity­rospo­rum fol­li­culi­tis: This fol­li­culi­tis caus­es red, itchy pus­tules on the back and chest caused by a yeast infec­tion.
• Gram-neg­a­tive fol­li­culi­tis: This type usu­al­ly occurs in peo­ple receiv­ing long-term antibi­ot­ic treat­ment for acne.
• Eosinophilic fol­li­culi­tis: This type of fol­li­culi­tis is com­mon­ly seen in immuno­com­pro­mised peo­ple as itchy bumps and pim­ples on the face and upper body.
• Pseu­do­fol­li­culi­tis: This type of irri­ta­tion is caused by ingrown hairs. It affects peo­ple with curly hair who shave or wax too close­ly.
• Furun­cles and car­bun­cles: occur when the hair fol­li­cle is deeply dam­aged by staphy­lo­coc­cus aureus. A furun­cle is a painful pink­ish bump, while a car­bun­cle is a large boil with its own char­ac­ter­is­tics. Read more about this com­mon infec­tion in chil­dren in the arti­cle “Furun­cles on the face and body of the baby: caus­es.”