Author(s): Dr Vidette Wong, Specialty Doctor in Medicine, United Kingdom (2024)
Reviewing dermatologist: Dr Ian Coulson (2024).
Edited by the DermNet content department
A woman in her 30s developed a widespread pruritic rash after a summer BBQ party with a hot tub. She was systemically well. A one week course of flucloxacillin did not appear to help the rash.
Other friends who attended the party had developed a similar rash.
Hot tub, Jacuzzi, or spa pool folliculitis. This is secondary to gram-negative bacteria such as Pseudomonas aeruginosa that may not respond to penicillin-based antibiotics.
Spa pool folliculitis is due to an opportunistic bacterial infection of the skin. Gram-negative bacteria can survive in warm water, even when adequately chlorinated. This is because of the formation of a biofilm on the tub surface or within the piping system.
It is hypothesised that water absorption into the stratum corneum increases proportionately with the time submerged in water, enhancing permeability to bacteria.
Hot tub or spa pool folliculitis is usually diagnosed based on the history of exposure and the clinical features. This condition is usually self-resolving and managed symptomatically.
A swab can be taken from the pustules for bacterial culture to determine antibiotic sensitivities. In this case, the patient’s antimicrobial was switched to ciprofloxacin with excellent response.
The responsible spa pool should be properly cleaned and disinfected.
