Swimmers itch from hot tub skin#
Skin biopsy of the folliculitis is not usually required. Culture and antibiotic sensitivities should be reported as isolates may show resistance to multiple antibiotics. Gram stain of a smear taken from pustules will show Gram-negative (pink/red) rods. Spa pool folliculitis is usually diagnosed based on the history of exposure and the clinical features. It is hypothesised that water absorption into the stratum corneum increases proportionately with the time submerged in water, enhancing permeability to bacteria. Contamination is more common if the water is inadequately treated or organic material, such as skin, is present. These ubiquitous Gram-negative bacteria can survive in warm water, even when adequately chlorinated, because of the formation of a biofilm on the tub surface or within the piping system. Spa pool folliculitis is due to an opportunistic bacterial infection of the skin by Pseudomonas aeruginosa or, less commonly, Aeromonas hydrophila. However, not all exposed individuals develop the infection, perhaps reflecting the duration of exposure, sex, and skin microflora. Immunocompromised patients may be predisposed to rapid skin colonisation by Gram-negative bacteria. All age groups and races can develop the condition following exposure.
Spa pool folliculitis predominantly affects females. The longer the duration and frequency of exposure the greater the risk. Examples of potential exposures include spa pools, hot tubs, jacuzzi, warm water swimming pools, rehabilitation pools, floatation tanks, whirlpools, floatation aids in swimming pools, contaminated toys in the family bath tub, wet suits, and industrial closed-loop water recycling systems. Spa pool folliculitis can affect the skin of anyone who has been exposed to warm wet environments.
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