Hot Tub Rash: Pseudomonas Folliculitis and Other Skin Infections

Urgent first

Most hot tub rashes are mild. But get medical care promptly if a rash comes with a high fever, if skin becomes painful, hot and swollen, or if you are unwell. The NHS (UK) tells people whose skin is painful, hot and swollen to seek urgent advice, because that can be cellulitis, a skin infection treated with antibiotics [1]. In a US emergency, call 911. Information only; this page is not medical advice.

What hot tub rash is

Hot tub folliculitis is an infection of the skin around hair follicles. MedlinePlus says it is caused by Pseudomonas aeruginosa, bacteria that can survive in hot tubs, whirlpools and swimming pools, and on wet objects such as towels, pool toys or sponges [2]. The Minnesota Department of Health calls it hot tub rash and says it often follows long contact with contaminated water [3].

What it looks like

MedlinePlus lists an itchy, bumpy, red rash that can start from several hours to 5 days after contact; bumps may fill with pus or look like acne, and the rash can be thicker under swimsuit areas where water stayed in contact with the skin [2]. Minnesota health officials add pus-filled blisters around hair follicles and say most rashes clear in a few days without medical treatment [3]. Some people feel ill, run a fever or have swollen lymph nodes [2].

Hot hand-foot and group outbreaks

A US hospital report describes a pool-party outbreak in which 33 children developed lesions, 6 to 48 hours after the party. Two were admitted with fever and painful nodules on the palms and soles, a pattern called hot hand-foot syndrome [4]. A case report notes that infection often presents as outbreaks among people using the same contaminated public water [5]. In one case report, only one of several family members who used a hot tub developed the rash, so not everyone exposed gets sick [5].

Why hot tubs

Minnesota health officials explain that hot tubs have warmer water than pools, so chlorine and other disinfectants break down faster, which can raise infection risk [3]. Good disinfectant and pH control make spread less likely [3]. This page gives no dosing or cleaning steps.

What helps, according to the sources

• MedlinePlus: treatment may not be needed, the mild form often clears on its own, anti-itch medicines can ease discomfort, and in severe cases a provider may prescribe an antibiotic [2].
• The condition usually clears without scarring; the problem may return if you use the hot tub again before it has been cleaned [2].
• Rare complication: a collection of pus (abscess) may form [2].
• A skin-infection review says local treatment is the cornerstone and prognosis is favorable in people with normal immunity [6].

Reducing the chance of rash

Minnesota advice: remove your swimsuit and shower with soap after getting out, clean your swimsuit, and ask the operator whether disinfectant and pH levels are checked regularly [3]. For checking a venue, see spa and facility safety checks before you go.

Who should take extra care

The same skin-infection review says serious Pseudomonas skin infections occur mainly in people with diabetes, heavy alcohol use or weakened immunity [6]. Anyone with diabetes, reduced sensation or open wounds should read hydrotherapy with diabetes, neuropathy and reduced sensation and ask a clinician before soaking.

When it may not be a hot tub rash

Other causes of a rash exist. A diagnosis is often made from the look of the rash and the history of hot tub use; sometimes a culture is taken [2]. Do not self-diagnose a rash that is spreading, painful or lasting beyond a few days; Minnesota advises seeing a provider if it lasts longer than a few days [3]. Different germs and allergic reactions can cause similar rashes; the sources we read do not compare them.

Related infections

Water can also carry other organisms. See Legionella and Legionnaires disease for the serious lung infection linked to hot tubs, and the warning signs checklist. We did not find a source we could read on other skin infections specific to hot tubs, so Proper evidence not found for a broader list here; we searched MedlinePlus, Minnesota Department of Health and PubMed.