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What Is Hot Tub Folliculitis in Children?

Medically Reviewed by Poonam Sachdev on April 08, 2022

When hair follicles on the body have inflammation due to injury, infection, or irritation, it is called folliculitis.  Folliculitis is recognized by swollen, painful areas in the neck, face, breasts, and buttocks. There is a particular form called hot tub folliculitis that is notably contagious and irritating, especially in kids. It is community-acquired, caused by bacteria, and occurs after exposure to contaminated water.

What Is Hot Tub Folliculitis?

Hot tub folliculitis is an infection of the skin surrounding hair follicles. The symptoms appear after contact with water that contains the bacteria Pseudomonas aeruginosa. Pseudomonas is found in warm, wet areas like whirlpools, hot tubs, and water slides. The bacteria enter through hair follicles or abrasions in the skin. 

If the contaminated water is exposed to your skin for an extended period of time, it can cause a folliculitis rash. The rash usually appears about a few days after sitting in an unmaintained spa or hot tub. It can also appear days after swimming in a lake or pool that is poorly maintained. 

Kids are affected more than adults, though anyone can get folliculitis if exposed to the bacteria. Other groups more prone to development are those with immunocompromised systems, those who already have dermatitis or acne, or people who have waxed or shaved recently.

Hot Tub Folliculitis Symptoms

The infection from hot tub folliculitis can start a few days to hours after exposure to contaminated water. It can begin as itchy bumps seen on the trunk of the body. Sometimes, those bumps develop into nodules and can contain pus. Areas obstructed by bathing suits can develop a more serious rash. People who wear one-piece swimsuits are more prone to infection.

The hot tub rash from hot tub folliculitis can affect any age. However, because of their playful activities, children get the infection more often. The following are the most common symptoms, though each child’s symptoms may vary:

  • Irritated, red hair follicles
  • Red, itchy bumpy rash
  • Damaged hair
  • Pus in the hair follicles

In mild cases, the rash may clear up in a few days on its own. Sometimes, though, systemic conditions may occur like malaise, fever, and fatigue.

What Else Does Hot Tub Folliculitis Look Like?

Insect bites sometimes look like folliculitis. The way to tell the difference is that bites are extremely itchy and develop on an exposed area. 

Some germs that are considered gram-positive can cause folliculitis. Other gram-positive germs cause similar bumps in young people who shave their legs, children who have diaper dermatitis, and those with other disorders that irritate the trunk and buttocks. Other, similar bumps can be caused by bromide sensitivity, acne, and gram-negative folliculitis.

Hot Tub Folliculitis Prevention

Improper care of water, elongated exposure to water, and too many people in a pool can all put someone more at risk for infection. Changing standing water frequently, having adequate chlorine levels, and constant water filtration can reduce the risk of infection.  

After swimming, remove the swimsuit and shower with soap. Taking a shower after swimming does get the chlorine off the skin, but it does not decrease the infection rate if already exposed. Wash your swimsuit as well, and hang it up to dry. Also, the use of testing strips to check the water in hot tubs or pools can tell if the water has a proper ph level and disinfectant level. 

How Is Hot Tub Folliculitis Diagnosed?

The diagnosis of hot tub folliculitis can be made by a doctor through a physical exam and medical history. When examining the sores, the doctor may take a culture. A culture is a sample of the wound drainage sent to a laboratory so that bacteria can be identified. Once the diagnosis of hot tub folliculitis is made, the doctor can select the best treatment.

Hot Tub Folliculitis Treatment

Hot tub folliculitis will usually clear up in around a week. If not, there are several things that determine what treatment is the best for kids. This is dependent on:

  • The child’s age
  • The child’s health and medical condition
  • How bad the rash is 
  • The tolerance for medication and therapy

Treatments used may include:

  • Warm compress to aid in drainage
  • Topical antibiotic solutions
  • Oral or IV antibiotics
  • Drainage of the sores via I&D

Topical solutions such as silver sulfadiazine applied two times a day can help. White vinegar applied to the rash a few times a day for twenty minutes is also beneficial. Oral antibiotics can be taken for 5 to 10 days for severe rashes or those resistant to the topical treatment.

Even if the rash resolves after a few days, it may leave behind a hyperpigmented red-brown area.  This area may take a few months to totally disappear.  

Are There Other Types of Folliculitis?

There are a few other types of folliculitis that need to be ruled out.

  • Bacterial folliculitis: This is a very common type, usually with white, pus-filled itchy bumps. It is usually caused by Staphylococcus aureus (staph), which is usually present on the skin at all times. 
  • Pityrosporum folliculitis: This folliculitis has red, itchy pustules on the back and chest, caused by a yeast infection. 
  • Gram-negative folliculitis: This type usually occurs in people getting long-term antibiotic treatment for acne. 
  • Eosinophilic folliculitis: This type of folliculitis is usually seen in people with HIV/AIDS. Bumps and pimples occur in patches, with itching on the face and upper body.  
  • Boils and carbuncle: These occur when there is a deep infection in the hair follicle with staph. The boil is a sudden painful pinkish bump. A carbuncle is a group of boils. 
  • Pseudofolliculitis barbae: This type of irritation is caused by hairs that are ingrown. It affects people with curly hair and people who shave too close that have curly hair.  It is seen mostly on the neck and face or in the case of people who get bikini waxes. 

Show Sources

SOURCES:

American Osteopathic College of Dermatology: “Children and Folliculitis, Boils, and Carbuncles.”

CDC.gov: “Hot Tub Rash (Pseudomonas/ Folliculitis).”

Childrens’ Hospital of Philadelphia: “Children and Folliculitis, Boils, and Carbuncles.”

Contemporary Pediatrics: “Pediatric dermatology: What's your Dx?”

Mayo Clinic: “Folliculitis”

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