Last updated: May 20, 2019
Richard Honaker M.D.
Primary Care Physician
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Soaking in a hot tub could put you at risk for folliculitis. Check out our guide to signs, symptoms, treatment and when you need to speak to a doctor.
Relaxing in a tub full of warm water after a long day is not only a great way to de-stress, but it can have wonderful health benefits as well. From lowering blood pressure levels to encouraging better sleep and weight loss, there are countless benefits from soaking in hot water.
Along with these benefits also come some big risks including hot tub folliculitis.
So how can you enjoy a good soak without ending up covered in itchy red bumps? We asked our resident GP Dr. Honaker to give us his insight on how best to avoid this itchy situation.
What is Hot Tub Folliculitis?
Hot tub folliculitis, also known as pseudomonas folliculitis, is a skin condition where bacteria that is commonly found in warm wet areas causes an infection in the lower area of the hair follicle. While this may seem like an ailment that could only affect those from the neck up, unfortunately this is not the case.
Your body is actually covered with hair follicles. In fact, with the exception of a few areas, (palms of your hands, soles of your feet, eyelids and lips) hot tub folliculitis could strike almost anywhere on your body.
The bacteria that causes hot tub folliculitis, Pseudomonas aeruginosa, thrives in moist and wet areas. It can also survive in chlorinated water. While it can be found in any type of warm water, it seems to thrive in wooden tubs.
Along with an itchy or painful bumpy rash, many people with this type of folliculitis may also experience other symptoms. Many sufferers report feeling generally unwell and many experience a sore throat, headache or nausea.
What Does Hot Tub Folliculitis Look like?
This type of folliculitis is characterized a bumpy rash that may be itchy. It often resembles acne and may or may not be filled with pus. As the rash forms it could also become painful to the touch.
Most people will develop the rash about 24-48 hours after exposure. You may notice that the rash has formed along the area of your body where the water level hit (chest) or it may form in the area under your swimsuit where bacteria was trapped for a longer period of time.
Who is at Risk?
Hot tub folliculitis can affect anyone who is using a hot tub, spa, jacuzzi or heated pool that is not regularly or properly treated. The type of bacteria that causes this type of folliculitis. Pseudomonas aeruginosa, can survive in chlorinated water and be difficult to kill off.
Here are some factors that can increase your risk of developing hot tub folliculitis:
- If you have a compromised immune system from a disease such as HIV/AIDS, leukemia, or diabetes.
- You have a skin condition that makes it easier for bacteria to penetrate the skin such as acne or dermatitis
- Shaving, waxing your body 24 hours prior to soaking or swimming
How do I know if I Have Hot Tub Folliculitis?
The good news is, in healthy skin, hot tub folliculitis will normally resolve itself in about a week without medical intervention. So if you suspect you have been infected, you may not necessarily need to visit your doctor.
Unfortunately for some, the infection may not clear up on its own. In that case, your doctor may be able to diagnose your folliculitis based on your health history and a visual inspection. Your doctor may also collect a sample of the fluid inside one of your bumps or even a small skin biopsy for testing.
When to call the Doctor
- You have a temperature above 101˚F (38˚C)
- If your folliculitis is spreading
- Your skin becomes warm, swollen and sore to the touch
Some cases of hot tub folliculitis will require oral or topical antibiotics (or a combination of both) from a doctor in order to heal the infection. If you are concerned that your folliculitis is not healing after a week, consult a healthcare professional.
Treatment for Folliculitis
While healthy skin would generally heal within a week, there are measures you can take to make yourself more comfortable while you are afflicted.
- Apply a warm wet washcloth to the affected area to ease itching and encourage healing
- Use anti-itching lotions and creams
- Apply apple cider vinegar or bathe in a bath containing apple cider vinegar
- Apply an antibacterial cream such as Bacitracin
How to Prevent Hot Tub Folliculitis
There are a few easier steps you can take to enjoy a relaxing soak and reduce your risk. As it is not ideal to simply avoid hot tubs and heated pools for the rest of your life. Hot tub folliculitis is found most often in hot tubs and spas that are not regularly or properly maintained. Keeping this information top of mind is helpful in reducing your risk.
You can also take the following steps:
- Before taking dip, ask the attendant on duty how often the water PH and chlorine levels are checked. Ideally, the levels should be checked twice daily.
- Avoid shaving, waxing and removing body hair 24 hours before going in a hot tub, spa or heated pool
- Have a shower immediately after swimming or soaking
- Wash your bathing suit thoroughly after every swim or soak
- Avoid sitting around in a wet bathing suit.
A Better Approach to Your Healthcare
While hot tub folliculitis is often itchy or possibly embarrassing, mild to moderate cases will normally heal on their own within two weeks without scarring. In rare extreme cases, the bumps could become infected and turn into abscesses which may need a doctor’s intervention.
The good news is, getting the advice of a doctor could be as easy hitting a button on your phone. Your Doctors Online is striving to connect patients and doctors around the world. By downloading our app, you have the expert advice of a doctor in the palm of your hand 24 hours a day, seven days a week. Best of all, the amazing service is absolutely free.
So you don’t have to worry about germy waiting rooms or sky-high costs. Your Doctors Online gives you the power to access better healthcare in the palm of your hand. Try us today.
Disclaimer: This article provides general information and is not intended to diagnose, treat or cure any disease or medical condition. If you require specific advice, please consult one of our medical professionals through the app. However, in case of an emergency, please call 911.
About Richard Honaker M.D.
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