Hot Tub Rash

Water activities have always been a favorite public past time during the summer months, but there are risks the public is not aware of. The bacteria Pseudomonas aeruginosa is lurking in these wet areas. Most of you may have heard of this bacteria after the British Petroleum oil spill since it was used to break down the oil due to its ability to spread. Although you may enjoy relaxing in the hot tub or a day at the water park, it can also cause an annoying skin rash. Hot tub folliculitis is also known as Pseudomonas aeruginosa folliculitis an obscure disease that is easily identifiable, preventable and treatable if certain information is made available to the public.

Hot tub folliculitis is an infection of the skin or hair follicles that is caused by the bacteria Pseudomonas aeruginosa. These bacteria are commonly found throughout the environment in water, soil and even on plants. Pseudomonas aeruginosa can also be found on the skin in 15% of the population. This bacterium is acquired from contact with contaminated water commonly found in hot tubs, spas, swimming pools, water slides, lakes, contaminated diving suits and even loofah sponges. Hot tubs made of organic sources such as wood are more likely to be infected because they provide a better environment for the bacteria. Medical facilities that use physiotherapy pools have been contaminated by this bacterium. The rash infects children more often than adults, because younger people spend more time playing in hot tubs and swimming pools. Pseudomonas aeruginosa usually only attacks compromised tissue. The organism is microscopic and cannot be seen with the naked eye. This makes it difficult to detect.

The two different types of Pseudomonas aeruginosa contamination are transitory and a continuing outbreak. Transitory contamination would be when the spa has too many people causing the level of sanitizer to decrease. This decrease creates a suitable environment for the bacteria to grow which increases the chance of transmission. A continuing outbreak occurs when the bacteria is allowed to multiple in the spa. This usually happens when the sanitizer levels fall low for a period of time. The bacteria then have the opportunity to infect all parts of the spa (water, filter and plumbing system). The bacteria can also be found on dirty and waterlogged spa covers. When sanitizer levels are too low for long periods of time Pseudomonas aeruginosa creates a slime layer know as a biofilm. This biofilm shields the bacteria from the sanitizer making it much harder to remove the contamination.

Hot tub rash can be confused with bug bites, chicken pox, keratosis pillars, acne, whiteheads, eczema, impetigo and atopic dermatitis. Several indicators of hot tub rash are history of hot tub use within last three days, itchy red rash appearing within two days of hot tub exposure, bumps that develop into dark red tender nodules, development of small blisters and multiple cases with the same rash and same hot tub exposure.

The most common symptom is an itchy rash that can resemble chicken pox or a bug bite appearing within a few hours after exposure. The tiny bumps develop into reddish color pimples that are 0.5 - 1 cm. in size. They often turn into puss filled blisters that appear around hair follicles located on areas of the body that have been subjected to friction ( rubbing of the bathing suit or edge of the pool for example) exposing the follicle to the bacteria. Common areas of the body to contract Hot tub rash include the trunk, abdomen or lower back, armpits, chest or upper back, upper arms and upper legs. The rash is usually more severe under areas covered by the swimsuit (groin and buttocks), which holds the bacteria close to the skin lengthening your exposure. Hot tub folliculitis can become very sensitive and are often extremely painful and/or