Hot Tub Folliculitis

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Hot tub folliculitis is a rash that can develop on the skin after bathing in a hot tub that isn't properly maintained. The last thing you want to be left with after a nice warm soak is a sore, itchy and often painful rash but the good news is it can easily be prevented. With a bit of knowledge about hot tub chemistry and a proper maintenance schedule you can greatly decrease your chances of developing hot tub dermatitis from unsanitary water. 

hot tub folliculitis

The key to preventing hot tub folliculitis is to understand what it is and how it can happen without any warning. In the unfortunate event that you, a family member or friend have to deal with this nasty rash, you will want to arm yourself with as much knowledge about it as possible. We'll take a look at the symptoms, treatment and most importantly, the preventative steps you can take.  


What is Hot Tub Folliculitis?

Hot tub folliculitis is also known as Pseudomonas aeruginosa folliculitis and results in inflammation and infection of the hair follicles. The Pseudomonas aeruginosa bacteria can be problematic in hot tubs, pools and fresh water. The bacteria can thrive in unsanitary, contaminated water for extended periods of time and after a swimmer takes a prolonged soak, the bacteria can infect the hair follicle in an unsuspecting person. 


Hot Tub Folliculitis Symptoms

The visual symptoms associated with hot tub rash are small red bumps that look like a rash, similar to chicken pox. The bumps will form anywhere from 6 hours to a week after bathing in a poorly maintained hot tub, jacuzzi, spa, whirlpool or pool. The pimple-like bumps can become extremely painful and itchy but should go away within 7 to 10 days if they aren't scratched or irritated. 

The rash will most likely be comprised of pus-filled blisters around the shaft of the hair follicle, hence the term folliculitis. The effected area can be an exposed area of skin or skin that was covered by a bathing suit or similar. It can affect bathers or swimmers of all ages but it's more commonly found on children and elderly with compromised immune systems.

In serious cases of infection you may experience a fever above 101˚F (38˚C). The skin surrounding the immediate area might also become red, warm, swollen or painful. If any of these serious symptoms occur, visit your doctor immediately as it may be an indication the bacteria is spreading.  

If you experience a rash or similar and suspect it might be from chlorine be sure to read our chlorine rash page. 


Treatment for Folliculitis

Most rashes caused by hot tub folliculitis will clear up in a few days on their own and without medical treatment. If the rash does persist beyond a few days, consult your local health care provider. The first thing is to avoid bathing in the infected hot tub or pool and avoid doing anything that aggravates the rash, including wearing tight clothing and scratching the infected follicles.  

If the rash is itchy you probably would do just about anything to relieve the itch and there are creams you can purchase designed just for this purpose. A quality aluminum acetate cooling gel will provide relief or you might want to consider an anti-bacterial benzoyl peroxide wash, both available over the counter from a drug store or market. 



Home Remedies for Folliculitis

These home remedies for hot tub folliculitis can help speed up the healing process as well as alleviating the itch. It will heal faster and prevent worsening if you avoid itching or aggravating the effected area by using any of the following:

  • Apply a clean, warm towel to the affected as often as needed.
  • Apply white vinegar or apple cider vinegar to the affected area directly, using a soaked cloth or soaking in a bath of diluted solution.

If the rash persists beyond a week, seek medical advice from a local practitioner. They may prescribe steroids, antibiotics or antibacterial ointments designed specifically to treat hot tub folliculitis. 


Hot Tub Folliculitis Prevention

Hot tub folliculitis is the most common type of follicle infection due to the fact that hot tubs are kept at temperatures between 98˚ to 104˚F. These high temperatures increase the degradation of the chemical disinfectant; chlorine and bromine. It's important to note that folliculitis can also be contracted from contaminated swimming pools, hydrotherapy pools, water parks and even fresh bodies of water like lakes and rivers. 

The chemistry of the hot tub is the most important factor in preventing the pseudomonas bacteria from existing and thriving in the water. A properly balanced hot tub will almost guarantee a safe and healthy environment for anyone using it. It's important to remember that heavy usage, urine or contaminants from food or natural debris; leaves and pine needles, can compromise the chemistry. 

The two levels of greatest concern are chlorine and pH which can be greatly affected by the above mentioned contaminants. The higher the pH, the more likely you will experience a colonization or growth of harmful bacteria due to the fact that chlorine and bromine become less effective as pH rises.

The bottom line is you should test as often as needed and maintain recommended chemistry levels at all times including:

  • 2-4 ppm (parts per million) of free chlorine in hot tubs
  • 4-6 ppm of bromine in hot tubs
  • 1-3 ppm of free chlorine in pools
  • pH level between 7.2 to 7.8 for both hot tubs and pools


Precautions to Avoid Hot Tub Rash

In addition to making sure the hot tub is sanitary and the hot tub filtration is up to par and working properly, there are some added precautions you can take to reduce your risk of hot tub folliculitis:

  • Avoid shaving immediately before using a hot tub.
  • Avoid waxing 24 hours before using a hot tub.
  • Change out of damp swimwear as soon as possible after soaking.
  • Shower with soap and warm water as soon as possible after soaking.
  • Clean your swimwear thoroughly after every use and don't just let air dry.
  • Check pH, Free Chlorine or Bromine levels twice a day during heavy use.



Cleaning Your Hot Tub

Cleaning a hot tub that is contaminated with Pseudomonas aeruginosa is an important step to eliminating the bacteria that caused the problem in the first place. If the hot tub isn't cleaned properly, you can experience outbreaks in the future when sanitizer levels drop out of recommended ranges. The bacteria can live in your plumbing and filters so it's essential to drain and thoroughly clean the hot tub after an outbreak

  1. Use a hot tub system flush product that circulates through the plumbing and filter system.
  2. Turn of the main power to the hot tub preferably at the main breaker board.
  3. Remove and discard the filters.
  4. Drain the hot tub.
  5. Clean the entire interior surface with a diluted bleach solution or antibacterial cleaner and rinse thoroughly with water. 
  6. Install the new filters.
  7. Refill the hot tub with fresh water.
  8. Turn the power on and start the system.
  9. Test the water and adjust pH as necessary. 
  10. Add sanitizer.
  11. A good hot tub shock should be used and allowed to circulate.
  12. Set to desired temperature between 100˚-104˚F and run for 24 hours.
  13. Test the water and adjust chemical levels if necessary.
  14. Enjoy your clean and balanced hot tub.

This list might seem like a lot but it's something that every hot tub owner should carry out when needed. It's worth doing for the peace of mind knowing that your hot tub is safe and will be enjoyed without the risk of bacteria growing in the water. 

Hot tub folliculitis is unfortunately a common problem in hot tubs but with a little education, preventative forethought and elbow grease it shouldn't be a problem for you down the road.


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