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Pseudomonas folliculitis in Adult
Other Resources UpToDate PubMed

Pseudomonas folliculitis in Adult

Contributors: Tyler Werbel MD, Susan Burgin MD
Other Resources UpToDate PubMed


Pseudomonas folliculitis, or hot tub folliculitis, is an infection of hair follicles with Pseudomonas bacteria. Outbreaks occur in people after exposure to a contaminated spa, swimming pool, hot tub, or water in the workplace. It is also associated with the use of contaminated water-associated objects, such as loofah sponges, swimming pool inflatables, rubber gloves, and nylon towels. Many outbreaks have been associated with inadequate chlorine levels. However, Pseudomonas is able to grow within biofilms despite normal chlorination. It also can be seen with higher incidence in patients on long-term antibiotic therapy for acne vulgaris.

Clinically, Pseudomonas folliculitis is characterized by tender or pruritic folliculocentric papules preferentially localized to the trunk, buttocks, and extremities. Inflammation of Montgomery's follicles of the breast has also been described in one outbreak in Alaska. Symptoms typically develop within 1-4 days after exposure to the contaminated water source. Infection can be associated with mild fever, malaise, lymphadenopathy, and leukocytosis. The cutaneous eruption usually fades within 7-14 days without therapy.

Water sources contaminated with Pseudomonas are also associated with outbreaks of painful plantar nodules termed the Pseudomonas hot-foot syndrome. These patients may or may not have a concomitant folliculitis.

There is no geographic distribution of Pseudomonas folliculitis. However, since hot tubs and natural hot springs are common activities of travelers and since pyodermas (purulent skin diseases) are among the most frequently reported complaints in returning travelers, a high degree of clinical suspicion is warranted.


L73.8 – Other specified follicular disorders

402921005 – Pseudomonas aeruginosa folliculitis

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Last Reviewed:10/21/2018
Last Updated:10/21/2018
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Patient Information for Pseudomonas folliculitis in Adult
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Hot tub rash (Pseudomonas folliculitis) is an infection of the hair follicle with Pseudomonas bacteria. It is most commonly seen in people who bathe in a contaminated spa, swimming pool, or hot tub.

Hot tub rash is usually resolved without treatment within 2 weeks.

Who’s At Risk

Hot tub rash can occur in people of any age, of any race, and of either sex.

Individuals with hot tub rash usually have a history of one of the following:
  • Bathing in a contaminated spa, swimming pool, or hot tub
  • Using a contaminated loofah sponge
  • Wearing a contaminated diving suit

Signs & Symptoms

The most common locations for hot tub rash include:
  • Groin and buttocks ("bathing suit" distribution)
  • Abdomen or lower back
  • Armpits
  • Chest or upper back
  • Upper arms
  • Upper legs
The rash appears as small (2-10 mm) pink to red bumps, which may be filled with pus or covered with a scab. Located around hair follicles, these bumps tend to be itchy or tender.

Hot tub rash typically arises within 1-4 days of exposure to the contaminated source. In addition to the rash, symptoms can include mild fever, headache, sore throat, and fatigue. Swollen and tender lymph nodes (glands that help produce antibodies, special proteins that fight off infection) may occur. Breast tenderness occasionally develops in both men and women, as glands in the nipple may become infected.

Although hot tub rash usually resolves within 7-14 days without treatment, the rash may leave behind patches of darker (hyperpigmented) skin. These patches are more pronounced in darker-skinned people and may take months to return to normal pigmentation.

Self-Care Guidelines

In order to prevent hot tub rash, proper maintenance and chlorination of pools, spas, and hot tubs is essential. Sponges and loofahs should be completely dried between uses in order to kill any bacteria.

If the rash is itchy, an over-the-counter antihistamine may be helpful.

When to Seek Medical Care

Make an appointment with your doctor if you develop an itchy or tender rash, especially if it is associated with fever, swollen lymph nodes, or breast tenderness.


Your doctor may wish to obtain a bacterial culture of one of the pus-filled bumps in order to establish the diagnosis.

No special therapy is required, typically. However, in severe cases, your physician may recommend the following:
  • Acetic acid compresses
  • An oral antibiotic, such as ciprofloxacin
  • Topical antibiotic cream, such as gentamicin


Bolognia, Jean L., ed. Dermatology, pp.1132. New York: Mosby, 2003.

Freedberg, Irwin M., ed. Fitzpatrick's Dermatology in General Medicine. 6th ed, pp.1860-1861, 1901-1902. New York: McGraw-Hill, 2003.
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Pseudomonas folliculitis in Adult
A medical illustration showing key findings of Pseudomonas folliculitis : Fever, Abdomen, Buttocks, Intertriginous distribution, Lower back, Primarily truncal distribution, Pruritus
Clinical image of Pseudomonas folliculitis - imageId=175997. Click to open in gallery.  caption: 'Numerous erythematous and edematous perifollicular papules on the flank.'
Numerous erythematous and edematous perifollicular papules on the flank.
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