Pseudomonas folliculitis in Adult
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Synopsis
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.
Codes
ICD10CM:L73.8 – Other specified follicular disorders
SNOMEDCT:
402921005 – Pseudomonas aeruginosa folliculitis
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Differential Diagnosis & Pitfalls
- Bacterial folliculitis
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Last Reviewed:10/21/2018
Last Updated:10/21/2018
Last Updated:10/21/2018
Patient Information for Pseudomonas folliculitis in Adult
Overview
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
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.Treatments
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
References
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.
Pseudomonas folliculitis in Adult