II. Epidemiology

  1. Children are more susceptible to Pseudomonas Folliculitis than adults

III. Causes: Pseudomonas aeruginosa contaminated water (e.g. Inadequately chlorinated)

  1. Whirpool or hot tub
  2. Contaminated loofah sponge
  3. Contaminated diving suit
  4. Waterslide or small pool

IV. Symptoms

  1. Onset 8 hours to 5 days (mean 2 days) after exposure
  2. Pruritic rash most severe in bathing suit area
  3. May be associated with systemic symptoms
    1. Malaise
    2. Fatigue
    3. Low grade fever

V. Signs

  1. Characteristics: Perifollicular lesions
    1. Initial
      1. Urticarial Plaque under 3 cm
      2. Central Pustule or Papule
    2. Healing
      1. Red-brown hyperpigmented lesions
  2. Distribution
    1. Most severe in areas under snug bathing suit
    2. Trunk and extremities affected
    3. Head usually not involved

VI. Course

  1. Resolves within 7-10 days
  2. May recur within first 3 months

VII. Management

  1. Self-limited infection resolves spontaneously
  2. Symptomatic therapy
    1. Acetic acid 5% compresses for 20 minutes bid-qid
    2. Silver Sulfadiazine (Silvadene) applied bid-qid
  3. Refractory or persistant cases
    1. Ciprofloxacin 500 mg bid for 5-7 days

VIII. Prevention

  1. Employ continuous Water Filtration
  2. Change hot tub or whirlpool water frequently
    1. Drain private hot tubs q1-2 months
    2. Drain public hot tubs daily
    3. Clean hot tub when drained with acidic cleaner
  3. Ensure adequate disinfection
    1. Keep Chlorine levels (1-3 mg/liter or >1 ppm)
    2. Maintain water pH 7.2 to 7.8
    3. Consider using bromine instead of Chlorine

IX. References

  1. Fitzpatrick (1992) Color Atlas Dermatology
  2. Habif (1996) Dermatology, p. 258-259
  3. Rhody (2000) Prim Care 27(2):459-73 [PubMed]
  4. Stulberg (2002) Am Fam Physician 66(1):119-24 [PubMed]

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Related Studies

Ontology: Pseudomonas aeruginosa folliculitis (C1274340)

Concepts Disease or Syndrome (T047)
SnomedCT 402921005
Spanish foliculitis por Pseudomona aeruginosa (trastorno), foliculitis por Pseudomonas aeruginosa (trastorno), foliculitis por Pseudomona aeruginosa, foliculitis por Pseudomonas aeruginosa
English Hot tub dermatitis, Pseudomonas aeruginosa folliculitis (disorder), Pseudomonas aeruginosa folliculitis