ContentsSynopsisCodesLook ForDiagnostic PearlsDifferential Diagnosis & PitfallsBest TestsManagement PearlsTherapyReferencesInformation for PatientsView all Images (26)
Pseudomonas folliculitis in Adult
Print Captions OFF
Other Resources UpToDate PubMed

Pseudomonas folliculitis in Adult

Print Patient Handout Images (26)
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

Look For

Subscription Required

Diagnostic Pearls

Subscription Required

Differential Diagnosis & Pitfalls

Consider alternative causes and organisms such as:

Best Tests

Subscription Required

Management Pearls

Subscription Required


Subscription Required


Subscription Required

Last Reviewed: 10/22/2018
Last Updated: 10/22/2018
Copyright © 2020 VisualDx®. All rights reserved.
Pseudomonas folliculitis in Adult
Captions OFF Print 26 Images Filter Images
View all Images (26)
(with subscription)
Pseudomonas folliculitis : Fever, Abdomen, Buttocks, Intertriginous, Lower back, Primarily truncal, Pruritus
Clinical image of Pseudomonas folliculitis
Numerous erythematous and edematous perifollicular papules on the flank.
Copyright © 2020 VisualDx®. All rights reserved.