Hot tub folliculitis is a term that describes a skin condition that can occur in unmaintained hot tub water. Bacteria left to breed in the water can multiply unchecked and begin to infect hair follicles. Especially in the hot water of a spa, maintaining the proper level of sanitizer in the water and keeping your filter clean will go a long way to avoiding this unpleasant condition.
The skin rash looks like red dots all over the stomach or arms and legs that can be itchy and also begin to spread to other parts of the body. Usually this condition may only last 1-2 weeks after infection, but extreme cases can cause more long term skin issues. If basic soothing crèmes or anti-itch over the counter products do not help after about a week, then a doctor should be sought out.
One of the main bacteria types that cause this condition is known as Pseudomonas aeruginosa, and this may also be confused with acne or other skin breakouts or blisters. Tall tale signs include the rash being more prevalent around bathing suit lines and underneath swim suits. The rash may only appear after a couple of days.
The top line of prevention includes measuring and maintaining sanitizer level in the spa. This is usually either bromine or chlorine. Having a bromine or chlorine water test kit or test strips on hand will assure proper levels can be maintained. Keeping the hot tub filter clean and rinsed off regularly also assure proper flow of the water filtration system and the removal of waste and biofilm. The pH of the water should also be maintained at a healthy level of around 7.2-7.6.
Sometimes adding chlorine or bromine is not enough, as it is the free chlorine or bromine that protects us against bacteria. A shock treatment (usually a non-chlorine shock) can quickly activate chlorine or bromine in the water and restore it to its bacteria fighting capability.
The causes of folliculitis are almost always the result of improper sanitizer maintenance and keeping the filter clean. Makeup, sweat and oils on the body can accelerate the problem in hot water as when hair follicles are damaged, they are more likely to become infected. Tight clothing is also an issue as it does not allow the exchange of treated water around those areas of the body, possibly trapping bacteria and damaging hair follicles at the same time.
For this reason, also never enter a hot tub with an open wound or cut as the bacteria can also spread to nearby hair follicles.
For treatment, try soothing lotions, anti-itch cream or even antifungal or antibiotic creams if the area does not clear on its own. You will need to see a doctor if you develop a fever, or if the condition worsens and spreads or you are experiencing pain.
Showering before and after the hot tub is a good way to help prevent this problem, even if you have been in moderately unmaintained water. However, water that is grossly out of balance can cause the condition easier. If you are using a public hot tub, it is a good idea to wash off with anti-bacterial soap right after use. Never assume the water is perfectly maintained in public places.
Most at risk are teenagers and younger adults, so this age group should always shower after a hot tub session.
Keep your spa filter clean by rinsing it off regularly with a garden hose, keep your water chemistry balanced and enjoy your hot tub!