Hot Tub Itch

There is nothing quite like slipping into a hot tub after a day of battling the winter elements. The positive memories of the experience can quickly fade if the event is followed by hot tub itch, medically known as pseudomonas folliculitis.  If an itchy rash consisting of elevated bumps, some pus filled, appears within 12 to 48 hours after a hot tub immersion then it is likely hot tub folliculitis. These bumps may develop into dark red, tender papules.

What causes hot tub itch?

A hot tub rash occurs when a bacteria known as Pseudomonas enters the pores of the skin causing an infection. Pseudomonas lives naturally and without consequence in the skin of about 15% of the population.

If Pseudomonas is introduced into improperly treated and maintained hot tub water the bacteria will take up residence in it. Once this happens it is very difficult to ‘evict’ because the bacteria develops a slimy layer that protects it from recommended levels of hot tub disinfectants. Super chlorination may help to get rid of the problem but it might be necessary to drain and scrub the tub with bleach in order to ward off the infestation.

The second way that pseudomonas may infect hot tub enthusiasts is at a ‘hot tub party.’ Large numbers of people in a hot tub may cause a temporary drop in the disinfectant levels in the tub. This allows the pseudomonas from a carrier (the 15% of the population who carry pseudomonas naturally) to travel to other participants at the party. The hot water causes skin pores to open and the bacteria finds new hosts in the follicles of fellow partiers. Once the party is over and the tub is vacated the disinfectant levels increase and the remaining bacteria is killed before it has time to become established in the water. The party goers however go home with an unexpected and often unwelcome companion in the form of hot tub itch.

What can be done to treat hot tub itch?

Hot tub folliculitis given time will resolve spontaneously however most people do not like the appearance and the itch can drive them crazy. An antibiotic (Cipro) will rid the body of the bacteria and a medicated cream containing 2% hydrocortisone is helpful in managing the itch.

Author: Patricia Johnston