Hot Tub Folliculitis: Causes, Symptoms, & Prevention

A relaxing evening spent soaking in a bubbling hot tub, the cares of the day melting away in the warm embrace of the water. It’s the epitome of relaxation, right? But what if we told you that hidden within those comforting jets and soothing bubbles could be a not-so-pleasant surprise known as “hot tub folliculitis”?

Hot tub folliculitis, often referred to as “hot tub rash,” is an unwelcome hitchhiker that can turn your blissful soak into an itchy, red nightmare. In this blog post, we’re going to dive headfirst into the world of hot tub folliculitis, exploring its causes, symptoms, prevention, and even some soothing solutions to ensure your hot tub experiences remain pure relaxation. 

What Is Hot Tub Folliculitis?

Hot tub folliculitis, also known as “hot tub rash” or “Pseudomonas folliculitis,” is a skin condition that can put a damper on your hot tub enjoyment. It’s essentially an infection of the hair follicles, typically caused by exposure to water contaminated with certain bacteria, particularly Pseudomonas aeruginosa.

When you immerse yourself in a hot tub or swimming pool, your hair follicles and skin come into contact with the water. If that water contains harmful bacteria like Pseudomonas aeruginosa, it can infiltrate your hair follicles and cause an infection. The warm, moist environment of hot tubs provides the perfect breeding ground for these bacteria, making hot tubs a prime location for hot tub folliculitis to rear its unwelcome head.

This condition isn’t life-threatening, but it can be incredibly uncomfortable. Hot tub folliculitis typically manifests as itchy, red bumps on the skin, often resembling a rash or acne outbreak. Fortunately, with the right knowledge and preventative measures, you can avoid falling victim to this irritating condition and continue enjoying your hot tub time without worry. 

Signs and Symptoms of Hot Tub Folliculitis

Though usually not serious, it can be quite uncomfortable and irritating. Recognizing its signs and symptoms early is key to seeking appropriate treatment and preventing further discomfort. 

Here are the common signs and symptoms associated with hot tub folliculitis:

  • Itchy Skin: One of the earliest and most common symptoms of hot tub folliculitis is itching. You may notice persistent itching in the areas where your skin came into contact with the contaminated water.
  • Red Bumps: Within 6 to 48 hours of exposure, small, red bumps begin to appear on the affected areas. These bumps often resemble acne or small insect bites. They can be raised or pus-filled and may be surrounded by redness.
  • Clusters of Bumps: The bumps tend to cluster together, forming patches or groups on the skin. This clustering is a distinctive feature of hot tub folliculitis.
  • Tenderness or Discomfort: The affected skin may become tender or sore to the touch, especially if the condition progresses or if the rash becomes more severe.
  • Pimple-like Appearance: The individual bumps may resemble pimples, with a central pus-filled head. However, unlike regular pimples, they occur in areas where hair follicles were exposed to the contaminated water.
  • Gradual Spreading: It can spread if not treated promptly. The rash may gradually expand to cover larger areas of the body, depending on the extent of exposure and the presence of risk factors.
  • Fever (Rare): In severe cases or when the infection spreads beyond the hair follicles, some individuals may experience a mild fever. This is less common but should be taken seriously.
  • Resolution: In most cases, hot tub folliculitis resolves on its own within a week or two, even without treatment. However, it’s essential to avoid scratching the affected areas to prevent secondary infections or scarring.

If you suspect you have hot tub folliculitis or experience any of these symptoms after hot tub exposure, it’s advisable to seek medical advice for proper diagnosis and guidance on treatment options. 

Causes of Hot Tub Folliculitis

Hot tub folliculitis is triggered by specific bacteria, which thrive in warm, moist environments like hot tubs and swimming pools. Understanding the causes of hot tub folliculitis is crucial for preventing its development. 

Here’s a closer look at how this condition develops:

  1. Bacterial Contamination: The primary cause of hot tub folliculitis is exposure to water contaminated with Pseudomonas aeruginosa bacteria. These bacteria are commonly found in soil, water, and the skin, and they can multiply rapidly in inadequately maintained hot tubs and pools.
  2. Warm Water Environment: Hot tubs are typically maintained at temperatures ranging from 98°F to 104°F (37°C to 40°C). These warm waters are ideal breeding grounds for bacteria, including Pseudomonas aeruginosa, which thrive and multiply at elevated temperatures.
  3. Inadequate Disinfection: Hot tubs and pools should be properly disinfected and maintained to control bacterial growth. Inadequate disinfection or imbalanced water chemistry can allow harmful bacteria to proliferate, increasing the risk of folliculitis.
  4. Insufficient Chlorine or Bromine Levels: Chlorine and bromine are commonly used chemicals to sanitize hot tub water. When these disinfectants are present in inadequate amounts or not properly distributed, they may fail to eliminate or control bacterial contamination effectively. Here, you’ll find some of the best chlorine tablets for hot tubs.
  5. Improper pH Levels: The pH level of hot tub water plays a crucial role in disinfection. If the pH is too high or too low, it can affect the effectiveness of chlorine or bromine and create conditions conducive to bacterial growth. Check water pH levels with these testing kits
  6. Inadequate Filtration: Proper filtration is essential to remove impurities and maintain water quality. If the filtration system is not functioning correctly or is poorly maintained, it can contribute to bacterial contamination.
  7. Contaminated Swimsuits and Towels: Bacteria can adhere to swimsuits, towels, and other fabrics. Reusing contaminated swimwear without washing it can reintroduce bacteria to your skin during subsequent hot tub sessions.
  8. Long Exposure Times: Spending extended periods in a hot tub can increase the likelihood of bacterial exposure and subsequent folliculitis, especially if the water quality is compromised.

Diagnosis and Medical Treatment of Hot Tub Folliculitis

If you suspect that you have hot tub folliculitis or experience the characteristic symptoms after exposure to a hot tub or pool, it’s essential to seek medical attention for proper diagnosis and treatment. 

Here’s what you can expect in terms of diagnosis and the available medical treatments:


  • Physical Examination: A healthcare professional will typically begin by conducting a physical examination of the affected areas. They will look for the characteristic signs of hot tub folliculitis, such as red bumps clustered around hair follicles.
  • Medical History: Your doctor may ask about recent activities, including whether you’ve been in a hot tub or pool, as well as any relevant medical history.
  • Microscopic Examination: In some cases, a sample of the pus or fluid from the affected bumps may be collected and examined under a microscope to confirm the presence of bacteria.
  • Bacterial Culture: In more severe or persistent cases, a bacterial culture may be taken to identify the specific bacteria causing the infection. This can help determine the most effective treatment.

Medical Treatment:

The treatment approach for hot tub folliculitis may vary depending on the severity of the condition and the individual’s overall health. 

Here are common treatment options:

  • Antibiotics: If the diagnosis confirms a bacterial infection, your doctor may prescribe antibiotics. Oral antibiotics are often effective in treating hot tub folliculitis. The choice of antibiotic may depend on the identified bacteria’s susceptibility to specific medications.
  • Topical Antibiotics: In mild cases or for localized infections, your doctor may recommend topical antibiotic creams or ointments. These can help reduce bacterial growth and alleviate symptoms.
  • Antibacterial Cleansers: You may be advised to cleanse the affected areas with antibacterial soap or solutions to prevent the spread of the infection.
  • Pain and Itch Relief: Over-the-counter pain relievers and anti-itch creams or lotions can provide relief from discomfort and itching associated with hot tub folliculitis.
  • Avoidance of Hot Tubs: During treatment, it’s advisable to avoid further exposure to hot tubs or pools to prevent reinfection or worsening of the condition.
  • Follow-Up: It’s important to follow your doctor’s instructions and complete the full course of antibiotics if prescribed. Failure to do so could lead to the recurrence of the infection.

Prevention Tips

Preventing hot tub folliculitis is far easier and more enjoyable than dealing with the discomfort it brings. By following these preventive measures, you can significantly reduce the risk of developing this irritating skin condition and continue enjoying your hot tub experiences worry-free:

1. Choose Clean and Well-Maintained Hot Tubs

Prioritize hot tubs that are properly maintained and regularly cleaned by reputable establishments.

Consider personal hot tubs where you have control over maintenance and cleanliness.

2. Perform Water Quality Checks

Use water testing kits to monitor the pH levels, chlorine or bromine levels, and water clarity regularly.

Maintain proper water chemistry to inhibit bacterial growth.

3. Shower Before Entering

Always shower before entering a hot tub to remove sweat, dirt, and any contaminants from your skin.

Pay special attention to areas with hair, as these are more prone to infection.

4. Limit Hot Tub Time

Avoid prolonged periods in hot tubs, especially when the water temperature is high.

Take breaks to cool down and minimize the risk of bacterial exposure.

5. Wear Clean Swimwear

Ensure your swimsuit is clean and free of contaminants before entering the hot tub. Wash your swimsuit after each use and avoid reusing it without washing it.

6. Maintain Personal Hygiene

Wash your hands thoroughly after using the restroom or handling any contaminants. Avoid touching your face or other areas of your body while in the hot tub.

7. Stay Hydrated

Drink plenty of water to stay hydrated while in the hot tub, as this can help your body fight off potential infections.

8. Exit and Rinse Off Afterward

After leaving the hot tub, rinse off with clean, fresh water to remove any remaining chemicals or contaminants. Pat your skin dry gently, avoiding excessive rubbing, which can irritate the follicles.

9. Keep Your Hot Tub Clean

Regularly clean and sanitize your hot tub’s filter and circulation system. Follow the manufacturer’s maintenance guidelines to ensure water quality.

10. Educate Yourself

Be aware of the signs and symptoms of hot tub folliculitis so that you can seek prompt treatment if needed.

11. Consult a Professional

If you maintain a personal hot tub, consider having it professionally inspected and serviced periodically to ensure it’s in optimal condition.

When to Consult a Healthcare Professional for Hot Tub Folliculitis

Hot tub folliculitis is generally a self-limiting and mild condition that often resolves on its own or with over-the-counter treatments. However, there are instances when it’s essential to seek medical advice and consult a healthcare professional. 

  • Severe Symptoms: If your symptoms are severe, including intense itching, widespread rash, or significant discomfort, it’s advisable to consult a healthcare professional for a proper evaluation.
  • Pus or Drainage: If the bumps become filled with pus, start draining, or show signs of infection, medical attention is needed to prevent complications.
  • Fever: If you develop a fever along with hot tub folliculitis, this could be a sign of a more serious bacterial infection. Contact a healthcare provider promptly.
  • Prolonged Symptoms: If your symptoms persist for more than two weeks despite home remedies and over-the-counter treatments, consult a doctor for a comprehensive assessment.
  • Recurrent Infections: If you experience recurrent episodes of hot tub folliculitis, it’s important to discuss this with a healthcare professional. They can help identify potential underlying causes or contributing factors.
  • Underlying Health Conditions: If you have a weakened immune system due to a medical condition or medication, consult a healthcare provider as soon as you notice symptoms. You may be at a higher risk of complications.
  • Risk of Secondary Infections: Avoid scratching the affected areas, as excessive scratching can lead to open sores and increase the risk of secondary bacterial infections. If you suspect secondary infections, seek medical attention.
  • Uncertain Diagnosis: If you are unsure whether your skin condition is hot tub folliculitis or another skin issue, it’s best to consult a healthcare professional for a proper diagnosis.
  • Concerns About Treatment: If you have concerns about the prescribed treatment or experience adverse reactions to medications, contact your healthcare provider for guidance and potential adjustments to your treatment plan.
  • Preventing Future Episodes: If you want guidance on preventing future episodes of hot tub folliculitis, a healthcare provider can offer recommendations and strategies tailored to your specific situation.

Remember that timely medical intervention can help alleviate discomfort, prevent complications, and ensure proper treatment if you have hot tub folliculitis. While many cases can be managed at home, it’s crucial to consult a healthcare professional when in doubt or when symptoms are severe or prolonged. Your health and well-being should always be the top priority.


Hot tub folliculitis might try to rain on your relaxation parade, but it doesn’t have to succeed. With knowledge and a few simple precautions, you can embrace the warmth of hot tubs and the joys of swimming pools without the itch.

This guide covered everything from its causes and symptoms to prevention and when to see a healthcare pro. By understanding the sources and being vigilant, you’re well-prepared for itch-free hot tub fun.

Remember, prevention is key. Opt for clean hot tubs, practice good hygiene, and stay aware of water quality. Enjoy the therapeutic benefits and relaxation, all while confidently keeping hot tub folliculitis at bay. Stay safe, and itch-free, and savor your aquatic adventures!