There are few things more relaxing than kicking back in a hot tub on vacation, but it’s possible to develop some not-so-nice side effects as a result. Hot tub folliculitis — sometimes also referred to as “pseudomonas folliculitis” or “Jacuzzi folliculitis” — is one of those complications.

Hot tub folliculitis is a skin infection that occurs around the lower parts of hair follicles. It’s caused by certain types of bacteria that thrive in warm, wet areas. It can occur in any hot tub, but the bacteria that cause it are particularly prone to thriving in wooden tubs.

The primary symptom of hot tub folliculitis is a bumpy, red rash that’s often itchy. The bumps may be filled with pus, and they can resemble acne. This rash may develop anywhere from a few hours to several days after exposure.

After it initially forms, the rash may develop into dark red nodules that are tender or painful. The rash may appear on the chest where the water level commonly hits. Or it may only appear in areas under the swimsuit, where the water and bacteria may have been trapped for longer.

Some people with this infection may feel a general sense of being unwell. They may have a sore throat, earache, nausea, or headache.

Hot tub folliculitis is caused by a type of bacteria called Pseudomonas aeruginosa, which thrives in warm, moist areas. Unlike most other types of bacteria, Pseudomonas aeruginosa can survive even in water that’s been chlorinated, making it difficult to kill off.

It’s most common in hot tubs and warm pools that aren’t treated regularly or thoroughly. These bacteria can cause an infection in the hair follicles of the skin. However, this infection can’t be transmitted from person to person.

Anyone can develop hot tub folliculitis when exposed to the bacteria, but some individuals may be more susceptible to the infection or its complications. This includes:

  • people who have a compromised immune system due to conditions like leukemia, HIV, or diabetes
  • those who already have acne or dermatitis, which can make it easier for the infection to penetrate the skin
  • anyone who has shaved, waxed, or epilated recently

The bacteria that cause hot tub folliculitis often don’t survive long within healthy skin. In such cases, the infection can resolve on its own within a week or so. If the folliculitis does not resolve, however, or if you have more symptoms than just a rash, you can make an appointment to see your doctor.

Your doctor may be able to diagnose the folliculitis just by examining the skin and asking about your medical history. If your doctor is unsure, they may take a sample of fluid from the blisters or a sample of tissue with a quick skin biopsy to send for testing.

If you have symptoms of a serious infection or an infection that’s spreading, make an appointment to see your doctor right away. These symptoms include:

  • a fever above 101˚F (38˚C)
  • spreading or recurring folliculitis
  • skin in the surrounding or immediate areas that’s red, warm, swollen, or particularly painful

Mild cases of hot tub folliculitis typically resolve without treatment within two weeks, and home treatments can help speed up the healing. These home treatments include:

  • applying warm compresses, which can help reduce itching and improve healing
  • using anti-itching creams or lotions to help relieve discomfort
  • applying antibacterial creams like Neosporin to the affected areas to prevent secondary infection
  • applying apple cider vinegar to the affected area, either directly or by soaking in a bath containing apple cider vinegar

If needed, your doctor can prescribe medications to help you fully kick the infection. This may include topical antibacterial ointments and topical or oral antibiotic medications. This will clear up the infection quickly.

Hot tub folliculitis is highly treatable. Most mild cases of hot tub folliculitis resolve on their own in two weeks or less, with symptoms resolving after the first week. Home treatments may help to resolve symptoms faster and promote healing.

If you do need help from your doctor treating the infection, most cases respond well to antibiotic regimens. It’s important, however, to take the prescriptions for the full amount of time they’ve been prescribed to you. Even if your symptoms clear up sooner, it’s essential to finish the full treatment or the infection may come back more resistant to antibiotics.

It’s possible to develop complications as a result of hot tub folliculitis. The most common complication is an abscess, which is an infected collection of pus. If you develop an abscess, you will need to be treated and possibly drained by your doctor.

Hot tub folliculitis typically heals without scarring. Leaving the rash alone while it heals instead of picking at it is essential for promoting healing and avoiding other infections or scarring.

The best way to prevent hot tub folliculitis is to only use hot tubs that you know have been regularly and thoroughly treated and cleaned. This means that the hot tub should have its acid and chlorine levels monitored and maintained, and the water filtration devices should be working. Because hot tubs have much warmer water than pools, the chlorine in them breaks down faster, meaning they’ll need more thorough treatment.

If your skin comes in contact with the bacteria, it isn’t always possible to prevent an infection no matter how fast you act afterward. That being said, there are some precautions you can take to reduce your risk. This includes:

  • Avoid shaving or removing hair immediately before using a hot tub. Waxing should be done at least a day or so in advance if possible.
  • Don’t sit around in a damp swimsuit. Immediately after getting out of the tub, shower and wash with soap and water.
  • Clean your swimsuit thoroughly after you’ve been in a hot tub. If you don’t, you could reinfect yourself at a later date.

If you’re concerned, you can ask the pool attendant how often the hot tub is serviced. Water that’s checked twice per day is typically safe.