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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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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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