Hot Tub Rash: Symptoms, Causes, Diagnosis, Treatment, and Prevention

Introduction

Hot tub rash is an infectious skin disease caused by Pseudomonas aeruginosa. It usually occurs after bathing in a contaminated or poorly maintained swimming pool, spa, or jacuzzi tub. The bacteria are known to thrive and multiply in warm and wet areas; hence, this infection is widespread in hot tubs or chlorinated swimming pools. Studies have shown that, on average, 67 percent of hot tubs and 63 percent of pools are infected with P. aeruginosa at any given time. Prolonged contact with contaminated water may result in a bumpy, itchy red rash over the skin. The symptoms usually present within hours to a few days after exposure to the contaminated water. Though this condition resolves in a few days, it may cause severe malaise and other systemic symptoms that might require medical assistance.

What Are the Other Names for Hot Tub Rash?

Hot tub rash is also known as hot tub folliculitis, jacuzzi folliculitis, or pseudomonas folliculitis.

What Are the Symptoms of Hot Tub Rash?

Though this condition may affect individuals of any age, children are more easily prone to get infected. This condition is increasingly seen in females than males. It can affect any body part but predominantly areas where the swimsuit has tightly adhered to the skin. The most commonly affected areas are the chest, trunk, face, buttocks, arms, genitals, armpits, and legs. The rash appears within one to four days of exposure to the source. It mainly presents as an itchy, bumpy red rash (two to ten mm) with inflamed hair follicles hence the term folliculitis. The bumpy rash may also be seen on the palms and soles. These bumps may resemble acne or may be filled with pus. These nodules may or may not be painful. In addition, patients might experience other generalized symptoms such as:

• Malaise.

• Fever.

• Headache.

• Eye pain.

• Sore throat.

• Swollen and tender lymph nodes.

• Diarrhea, nausea, and vomiting.

Though the rash resolves within 7 to 14 days, healing usually results in dark-pigmented patches of the affected areas. These hyperpigmented areas are more pronounced in dark-skin individuals and may take some time to return to normal pigmentation.

How Does Hot Tub Rash Occur?

Hot tub rash is caused by the bacteria Pseudomonas aeruginosa. This bacteria has an increasing affinity to damp places and is known to thrive in recreational water facilities, especially the ones that are poorly maintained. The most common source of this infection are:

• Pools with poorly maintained pH or improperly disinfected.

• Physiotherapy pools.

• Warm lakes and streams.

• Jacuzzi tubs.

• Spa pool.

• Inflatable pool toys.

• Water slides.

The following individuals are at increased risk of getting infected with this bacteria:

• Wearing a contaminated swimsuit or one that is not washed and dried properly.

• Wearing the contaminated suit for too long.

• Using a contaminated loofah or bath sponge.

• Patients with skin conditions such as dermatitis or eczema or those who have recently waxed or removed their body hairs.

• Immunocompromised individuals.

How Can Hot Tub Rash Be Diagnosed?

Diagnosis of hot tub rash is relatively straightforward. A thorough physical examination and history of water exposure in the pool or tub would rather lead to a conclusive diagnosis. These lesions usually resolve on their own; however, a long-standing infection may need additional diagnostic tests to rule out other skin conditions. A biopsy is then performed, where a fluid sample is taken from the blister and subjected to laboratory analysis. Other conditions which may mimic hot tub rash clinically are:

• Contact dermatitis.

• Acne.

• Other infectious folliculitis.

• Staphylococcus skin infection.

• Insect bites.

• A nodular variant of scabies.

How Is Hot Tub Rash Treated?

Hot tub rash usually requires no treatment and resolves on its own within 7 to 14 days. However, the following steps can help ease the symptoms:

• A warm compress over the infected areas can help relieve the pain.

• 1 % Hydrocortisone can help relieve the itchiness.

• Diluted white vinegar compress over the infected area for 15 minutes twice daily can also help relieve itchiness and pain and fasten the recovery.

• In case of severe infection, topical antimicrobials such as Gentamicin or Polymyxcin B can be used.

• Topical antibacterials like Neosporin can be used to prevent secondary infections.

• Oral antibiotic therapy may seldom be needed.

When to Seek Medical Help?

Seek medical help if the following symptoms persist:

• Persistent high-grade fever.

• Recurring or spreading folliculitis infection.

• The skin surrounding the rash is red, inflamed, and tender.

• No improvement in the rash even after 14 days.

• The rash has developed into huge boils or lumps.

• The breast or nipple is painful.

What Are the Complications Associated With Hot Tub Rash?

Hot tub rash is a self-limiting disease that rarely develops a complication. However, secondary infections may occur as a result of scratching or popping the blister. Abscess and skin pigmentation may also develop, though infrequently.

How Can Hot Tub Rash Be Prevented?

Hot tub rash can be prevented by:

• Showering with soap before and after using the pool or tub.

• Washing the swimsuit and drying it thoroughly after every use.

• Disinfect the bath sponges or loofah regularly.

• Check with the pool operator if the pool or tub is sufficiently disinfected and if the pH level is maintained.

• The Centers for Disease Control and Prevention (CDC) recommends maintaining a pH of 7.2 to 8 in hot tubs and pools.

• Tubs should be disinfected using free chlorine at 3 to 10 parts per million (ppm) or bromine at 4 to 8 ppm.

• Pools should be disinfected using 1 to 10 ppm of free chlorine or bromine 3 to 8 ppm.

Conclusion

Hot tub rash is not a contagious condition. It is a bacterial skin infection that poses no grave threat and can very well be prevented. However, some cases might be severe and require prompt diagnosis and treatment. Considering their overlapping clinical features with other dermatological conditions, prolonged, unresolved cases must be distinguished from them and treated appropriately. Prevention is the best way to avert hot tub rash. Maintaining adequate sanitation, periodic disinfection of the public water recreational facilities, and ensuring sufficient self-hygiene are crucial to prevent hot tub rash.