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Folliculitis is a superficial infection of the hair follicle. Hot tub folliculitis is a folliculitis that develops after exposure to certain forms of bacteria that reside in warm, wet environments such as hot tubs. Folliculitis is the name given to a group of skin conditions in which there are inflamed hair follicles. The result is a tender red spot, often with a surface pustule. Folliculitis

can be due to infection, occlusion, irritation and specific skin diseases.

Folliculitis looks like a small, pus-filled pimple, usually around the base of a hair. Pus seeping from this pustule can be tinged with blood. While folliculitis can occur anywhere on the body, it is most likely to appear on the arms, armpits, legs, or on the scalp. Men who shave are more likely to develop folliculitis on the face. Folliculitis caused by an unsanitary hot tub is more likely to occur on the areas covered by a bathing suit, such as the buttocks. In some cases, folliculitis can result in a painful skin abscess called a boil. A boil is a pocket below the skin’s surface that contains pus and feels warm to the touch. It is rare, however, for folliculitis to cause a serious skin infection.

Folliculitis often starts with damage to your hair follicles — either from a blockage of the follicles or from friction caused by clothing or shaving. Once injured, the follicle is susceptible to infection by bacteria, yeast or fungi. Barber's itch, for example, is a bacterial infection that's aggravated by shaving. Tinea barbae — roughly, barber's itch in Latin — is a similar infection caused by a fungus. In many cases, the infection clears on its own. When it persists, your doctor may recommend treatment with a topical antibiotic. For more severe infections involving the entire follicle, you may need oral antibiotics or broad-spectrum antifungal agents.

Germs like warm water. Hot tub folliculitis is a specific rash caused by infection of the hair follicles of the skin with Pseudomonas aeruginosa, a particularly nasty bacterium. It usually begins between 6 hours to 3 days after sitting for a prolonged period in a poorly chlorinated hot tub or whirlpool. There are multiple, widespread pustules which may be seen on the trunk, buttocks, legs, and arms, and in my experience, especially in the areas covered by a tight-fitting Spandex bathing suit. The child may have some mild constitutional symptoms, including low grade fever and malaise. The infection can (rarely) cause serious abscess formation. There is no specific treatment - the pustules usually resolve by themselves within 7 to 10 days.

Every hair on your body grows from a follicle, a small pocket under the skin. Although follicles are densest on your scalp, they occur everywhere except your palms, soles and mucous membranes such as your lips. Each follicle is attached to a small muscle. When you're cold or frightened, the muscle contracts, raising the hairs above the level of your skin and giving the appearance of "goose bumps." Just above these muscles are sebaceous glands that produce an oil (sebum) that lubricates your skin and coats each hair shaft. Sebum is carried to the follicles and skin in tiny ducts. Normally, the follicles carry out these functions with few problems. But when they're damaged, they may be invaded by viruses, bacteria and fungi, leading to infections such as folliculitis.

Most folliculitis is caused by the common organism Staphylococcus aureus. Hot tub folliculitis is different in that it is caused by Pseudomonas aeruginosa. Pseudomonas survives in hot tubs, especially hot tubs made of wood, unless the pH and chlorine content are strictly controlled. Hot tub folliculitis becomes noticeable within half a day to two days after exposure. It first appears as itchy bumps, some of which may be filled with pus. It may then develop into dark red tender nodules. The rash may be more dense under swimsuit areas, where the material has held the contaminated water in contact with the skin for a longer period of time.

Bacterial folliculitis infections are usually mild and can be cleared up by applying an over-the-counter topical antibiotic cream or ointment to the affected area as directed by your doctor. If the infection covers a large area or multiple areas, your doctor may prescribe an oral antibiotic. If you have repeated occurrences of folliculitis, your doctor may recommend bathing with an antibacterial soap. If the folliculitis is caused by a fungal infection, your doctor will prescribe antifungal drugs and topical treatments.

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All information is intended for reference only. Please consult your physician for accurate medical advices and treatment. Copyright 2005,, all rights reserved. Last update: July 18, 2005