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Hot Tub Rash

Hot tub rash is an infection of the skin (dermatitis) or of the hair follicles in the skin (folliculitis) acquired from contact with contaminated water. "Hot tub rash" is many times incorrectly attributed to too much chlorine in the water when many times the culprit is actually  Pseudomonas bacteria contamination.

Causes of Hot Tub Rash

Hot Tub Rash infections are often caused by the germ Pseudomonas aeruginosa. This germ is common in the environment (water, soil) and is microscopic so that it can’t be seen with the naked eye.

Hot Tub Folliculitis Rash

The rash of hot tub folliculitis consists of several small .5 - 3 cm red papules or wheals with a central pustule.

Symptoms of Hot Tub Rash

The most common symptom is an itchy rash or small reddish bumps, sometimes confused with bug bites.

Two Types Pseudomonas Outbreaks

  • The most frequently seen kind is called transitory Pseudomonas contamination. When a heavy bather load (such as a party) occurs in the spa, all the sanitizer may be temporarily used up. This gives the organism an opportunity to spread from the carrier to others in the tub.  
  • The second kind of outbreak occurs when Pseudomonas has been allowed to set up residence in the spa.

Cure and Treatment of Hot Tub Rash

Treatment may not be needed, as the mild form of the disease usually clears on its own. Anti-itch medications may be used. In severe cases, an oral antipseudomonal antibiotic, such as a fluoroquinolone, may be prescribed. In the case described here, the doc- tor and patient decided together to allow the folliculitis to resolve on its own.

Prevention of hot tub rash

Showering after contact with contaminated water does not prevent infection.

To reduce the risk for outbreaks of "hot tub rash," pool and hot tub operators should:

  • Follow regulatory requirements for pH and disinfectant levels in hot tubs.
  • Ensure all staff members have a thorough knowledge of basic aquatic facility operation.
  • Monitor hot tub disinfectant levels on an hourly basis.
  • Perform regular checks of automated equipment to ensure that it is working properly.


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