Hot Tub Folliculitis Treatment and Diagnosis

Hot tub folliculitis is an infection of the skin around the lower part of the hair shaft (hair follicles). It occurs when you come into contact with certain bacteria that live in warm, wet areas.


Hot tub folliculitis is caused by the bacteria Pseudomonas aeruginosa. This form of bacteria survives in hot tubs, especially tubs made of wood. Controlling the acid and chlorine level in the water can limit the growth of the bacteria.

How is Hot tub folliculitis Spread at Recreational Water Venues?

  • Hot tub rash can occur if contaminated water comes in contact with skin for a long period of time.
  • The rash usually appears within a few days of being in a poorly maintained hot tub (or spa), but it can also appear within a few days after swimming in a poorly maintained pool or contaminated lake.
  • Most rashes clear up in a few days without medical treatment. However, if your rash lasts longer than a few days, consult your health care provider.


The first symptom of hot tub folliculitis is an itchy, bumpy, red rash. Symptoms can appear from several hours to 2 days after contact with the bacteria.

The rash may:

  • Turn into dark red, tender nodules
  • Have bumps that fill with pus
  • Look like acne
  • Be thicker under swimsuit areas where the water has been in contact with the skin longer
  • People who shared the hot tub may have the same rash.

Exams and Tests

Your health care provider can often make this diagnosis based on looking at the rash and knowing that you’ve been in a hot tub. Testing is usually not needed.


Treatment may not be needed. The mild form of the disease often clears on its own. Anti-itch medicines may be used to ease discomfort.

In severe cases, your health care provider may prescribe an antibiotic such as ciprofloxacin.

Outlook (Prognosis)

This condition usually clears without scarring. The problem may come back if you use the hot tub again before it has been cleaned.

Possible Complications

  • Abscess formation (rare)
  • Discomfort

When to Contact a Medical Professional

Call your health care provider if you develop symptoms of hot tub folliculitis.

How Do I Protect Myself and My Family?

Because hot tubs have warmer water than pools, chlorine or other disinfectants used to kill germs (like Pseudomonas aeruginosa) break down faster. This can increase the risk of hot tub rash infection for swimmers.

To reduce the risk of hot tub rash:

  • Remove your swimsuit and shower with soap after getting out of the water.
  • Clean your swimsuit after getting out of the water.
  • Ask your pool/hot tub operator if disinfectant (for example, chlorine) and pH levels are checked at least twice per day—hot tubs and pools with good disinfectant and pH control are less likely to spread germs.
  • Use pool test strips to check the pool or hot tub yourself for adequate disinfectant (chlorine or bromine) levels.
  • Pools: free chlorine (1—3 parts per million or ppm)
  • Hot Tubs: free chlorine (2—4 ppm) or bromine (4—6 ppm).
  • Both hot tubs and pools should have a pH level of 7.2—7.8.

If you find improper chlorine, bromine, and/or pH levels, tell the hot tub/pool operator or owner immediately.

Four Questions to Ask Your Hot Tub Operator

  • What was the most recent health inspection score for the hot tub?
  • Are disinfectant and pH levels checked at least twice per day?
  • Are disinfectant and pH levels checked more often when the hot tub is being used by a lot of people?
  • Are the following maintenance activities performed regularly:
  • Removal of the slime or biofilm layer by scrubbing and cleaning?
  • Replacement of the hot tub water filter according to manufacturer’s recommendations?
  • Replacement of hot tub water?

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