Hot Tub Folliculitis (Pseudomonas): Symptoms, Treatment & Prevention Guide

What Is It?

Hot tub folliculitis is a skin infection caused by Pseudomonas aeruginosa from poorly maintained hot tubs, spas, or pools. Incubation ranges from 8 hours to 5 days. Children and immunocompromised individuals face higher risk.

Symptoms

• Itchy, red papules and pustules—typically on areas covered by a swimsuit (trunk, axillae, buttocks)
• Low-grade fever, malaise, muscle aches, headache, nausea (systemic signs in ~20%)
• Typically self-limited, resolving in 7–10 days

Treatment

• Mild cases: Supportive care—warm compresses, antipruritics (oral antihistamines, topical corticosteroids).
• Moderate/severe/systemic cases: Oral antipseudomonal antibiotic (ciprofloxacin 500 mg twice daily for 7–10 days; TMP-SMX as alternative).
• Limited lesions: Topical antibiotics (mupirocin).

Prevention

1. Maintain free chlorine 3–10 ppm / bromine 4–8 ppm; pH 7.2–7.8.
2. Shower with soap before and after use.
3. Avoid if you have open wounds or active skin infections.
4. Clean filters regularly; replace water per manufacturer schedule.
5. Moisturize after showering to preserve skin barrier.

Seek medical care if fever exceeds 38.5°C, erythema spreads, or you're immunocompromised.