Overview

Hot tub rash, medically known as folliculitis, is a skin infection that commonly occurs after using hot tubs, spas, or heated pools. It is caused by bacteria that infect hair follicles, leading to red, itchy bumps or pus-filled blisters on the skin. The condition is generally mild and resolves on its own, but in some cases, it can be uncomfortable and persistent. Hot tub rash is most often associated with poor water hygiene and improper chlorination. While it can affect people of all ages, children and individuals with sensitive skin are more prone to developing this rash.

Causes

The primary cause of hot tub rash is an infection of the hair follicles by a bacterium called Pseudomonas aeruginosa. This bacteria thrives in warm, moist environments, particularly in hot tubs or pools where the chlorine levels and pH balance are not properly maintained. Contributing factors include:

• Prolonged exposure to hot tubs or heated pools: Extended time in improperly maintained hot tubs increases exposure to bacteria.
• Wearing swimsuits for long periods: Tight-fitting swimwear can trap contaminated water against the skin.
• Poor water hygiene: Insufficient cleaning and disinfecting of hot tubs allow bacteria to multiply.
• Shaving before hot tub use: Small cuts from shaving can make it easier for bacteria to infect hair follicles.

Symptoms

Symptoms of hot tub rash typically appear within 12 to 48 hours after exposure and can include:

• Red, itchy bumps: Often appearing in areas covered by swimwear, such as the torso, buttocks, or thighs.
• Pus-filled blisters: Small fluid-filled bumps may develop around hair follicles.
• Tenderness or discomfort: Affected areas may feel sore or painful to touch.
• Mild fever: In some cases, a low-grade fever may accompany the rash.
• Worsening after bathing: Symptoms can become more noticeable after showering or bathing due to skin irritation.
• Itching or burning sensation: The rash may be associated with significant itchiness or a burning feeling.

Diagnosis

Hot tub rash is usually diagnosed through a clinical examination by a healthcare provider. Diagnosis steps include:

• Physical examination: A doctor will inspect the rash's appearance, distribution, and characteristics.
• Medical history: Questions about recent use of hot tubs, spas, or pools help establish the connection.
• Swab culture (in rare cases): If the rash is severe or unresponsive to treatment, a skin swab may be taken to identify the specific bacteria.

Treatment

Most cases of hot tub rash are mild and resolve without medical treatment. However, some individuals may require specific care to relieve symptoms and speed recovery:

• Self-care measures:
  • Showering with soap immediately after using a hot tub or pool to remove bacteria from the skin.
  • Applying warm compresses to soothe irritated skin and promote healing.
• Over-the-counter treatments:
  • Topical antibacterial creams or ointments, such as bacitracin or mupirocin.
  • Anti-itch creams like hydrocortisone to reduce itching and inflammation.
  • Oral antihistamines to help relieve itching and allergic-type symptoms.
• Medical treatment: In more severe or persistent cases, a doctor may prescribe oral antibiotics targeting Pseudomonas aeruginosa.

Prognosis

The prognosis for hot tub rash is excellent in most cases. The rash typically clears up within 7 to 10 days without long-term effects. Symptoms tend to improve quickly with proper skin care and hygiene measures. Rarely, if the rash worsens or becomes infected more deeply, further medical treatment may be necessary.

Preventing hot tub rash involves practicing good hygiene, ensuring proper maintenance of hot tubs, and showering after water activities. People can enjoy hot tubs and pools safely by following these preventive steps and minimizing risk factors, making recurrence unlikely for most individuals.