We’ve had some hot days this spring and many people are ready to fill up the hot tub and have a nice soak. Be warned though, there is a chance that your hot tub could be hosting an unseen danger which can result in skin irritation or a rash. Also, it may not erupt immediately so you can easily think it was due to another cause. Last week one of my clients came in and told me that a rash that she thought was due to an allergic rash to wheat products was actually a hot tub reaction.
A hot tub rash or folliculitis is called by a hardy little organism called as Pseudomonas aeruginosa. This organism thrives in hot water and it can remain hidden in the nooks and crevices of a hot tub for an indefinite period of time. As soon as a person uses the pool, the infecting organism enters skin through the skin pores and infects the epidermal or top layer of skin. It actively kills host cells and reproduces in the skin pore causing the red dots or rashes that appear. This infection is usually limited to the top layers of skin and the person will note an immediate or delayed red rash all over the body.
Typically, red dots or spots appear all over the body but they appear more concentrated in areas that were covered with a swimsuit. The rash is limited to the upper layers of skin but it may spread deeper into skin forming small pus filled pimples that are about 2mm-7mm in size. For some people, the rash may appear 24-48 hours after using the hot tub but the physical appearance is the same.
The rash is spread out all over the body but a few people do have larger red spots along the groin region, the buttock region, armpits, back and upper legs. The problem is that Pseudomonas basically infects hair follicles and the human body is covered with hair everywhere! As a result, the rash can literally be anywhere on your body. A few people may also have fever, mild malaise, headaches, sore throats, swollen lymp nodes and other general symptoms that will require medical care.
The good news is that these rashes go away by themselves in 7-10 days. The bad news is that the rash itches like crazy and there is a chance that the rash can temporarily leave black hyper-pigmented patches on the skin. The patches do fade with time though. Most doctors recommend vinegar compresses over the rashes applied for 20 minutes two to four times a day. This can be combined with topical creams like silver sulfadiazine and hydrocortisone 1% to reduce the itching. Bathing with fragrance-free oatmeal based soap is also helpful in reducing the itching and controlling the rash. A few doctors recommend using Burow’s solution which contains a mix of water and aluminum acetate or tea tree oil-based body washes to control the bacterial infection.
Try to avoid shaving or any type of hair removal procedure till the condition clears up completely. If the condition spreads deeper in to skin causing pus formation, fever and sore throat, doctors may prescribe a systemic antibiotic like ciprofloxacin.
Prevention of Rashes from Hot Tubs
It is completely possible to control this condition. Ideally, the pool or hot tub should be checked regularly by health inspectors to ensure that it has been sterilized with chlorine, bromine or other pool sterilizers. The pH of the water should be checked too. For example, properly sterilized pools and hot tubs should contain 1-4 parts per million of chlorine or bromine and the pH level should be about 7.2-7.8. Even if the pool checks out, make sure that you shower with soap before and after using the pool and rinse out your swimwear with soap immediately.
Caution- Be Careful About Your Condition
It’s very possible that you have chlorine, bromine or even pool algicide allergies that seem to resemble a hot tub rash. Always get a doctor’s opinion for any medical condition and do not self-medicate.