Hot tub folliculitis is a superficial skin infection caused by Pseudomonas bacteria. It occurs following exposure to inadequately treated water in spas and hot tubs. The rash consists of red elevated lesions (papules), some of which may be pus-filled. The rash may appear 12 hours to 2 days following exposure, typically itches, and usually resolves spontaneously.
Most folliculitis is caused by the common organism Staphylococcus aureus. Hot tub folliculitis is different in that it is caused by Pseudomonas aeruginosa. Hot tub folliculitis becomes noticeable within half a day to two days after exposure. It first appears as itchy (pruritic) bumps, some pus filled, and may develop into dark red tender nodules . The rash may be denser under swimsuit areas where the material has held the contaminated water in contact with the skin for a longer period of time.
Pseudomonas is a common problem in warm water pools and spas in particular. Fortunately the most common symptom is an itchy rash. It is often confused with bug bites (often complaints are received that a hotel has "bed bugs"), chicken pox, and other types of rashes. It can occasionally be much more serious including severe rashes requiring hospitalization, ear infections, urinary and vaginal infections, and probably most serious is pneumonia.
There are two kinds of Pseudomonas outbreaks. Most often seen is what some call transitory Pseudomonas contamination of a spa. About 15% of the population have Pseudomonas as a naturally part of the flora and fauna of their skin. When a "party" occurs in the spa, all the disinfectant is used up and the organism is spread to everyone in the tub from the carrier. Because the hot water opens up the pores, the Pseudomonas can enter the pores, "follicles", in the skin, even of the carrier, and will cause the Pseudomonas Folliculitis problems. Once the party is over, everyone gets out, the spa can reestablish the disinfectant residual and the organisms are killed before setting up residence in the spa.
The second kind problem is when Pseudomonas sets up residence in your spa. If the disinfectant residual is not re-established soon enough, the organism can set up residence in the water. This is a much more serious problem for maintenance. Once it sets up residence, it covers itself with a slime layer to protect itself against the chlorine.
It likes to set up residence on surfaces, and is often found in areas of low flow. Sometimes in such large amounts that one can scoop out a handful of the stuff. Generally superchlorinating will eliminate most infestations.
As a prophylactic measure one can drain the spa after several hours of high chlorine, and brush and scrub the spa with a 200-ppm solution of chlorine (2 oz. of household bleach per gallon of water, or 1 oz of 12% hypochlorite solution). The key is to brush and break up the protective layer.
Conscientious maintenance of disinfectant is the best procedure, don't let is set up residence in the first place, and kill it before it passes from person-to-person.
Procedure for Chemical Cleansing
Superchlorination and Neutralization:
Water Replacement and Treatment:
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