Hot Tub Folliculitis: Prevention And Treatment


Every homeowner desires to have a hot tub set upright in their backyard. But who could have thought that this so coveted muscle-relaxing equipment could bring some not-so-nice side effects on your skin?

Hot tub folliculitis, or as most people call it hot tub rash, is one of such complications and can affect anyone regardless of how young or old they are. So are you doing what is needed to protect your loved ones from this menace?

A spa rash is a peace-depriving nightmare that you wouldn’t wish on anyone. Good news? It can be avoided and treated before it escalates to a life-threatening condition. The purpose of this article is to provide you with in-depth information on folliculitis so that you can have safe, enjoyable soaks.

What Is Hot Tub Folliculitis?

Also known as Pseudomonas Dermatitis or hot tub rash, hot tub folliculitis is a common skin condition that emanates from using a poorly maintained spa or swimming pool. This is usually a bacterial infection and needs to be attended to as soon as it occurs. When you develop folliculitis, your hair follicles get inflamed forming what appears like white-headed pimples or red bumps around them.

Spa rash is not a serious condition but can be embarrassing, sore, and itchy. If not addressed early enough, it can develop into crusty sores with severe infections causing scarring and permanent hair loss. If your case is mild, you will only need to take basic self-care measures for it to clear. Recurring conditions or severe cases, however, will need to be treated by a doctor.

Causes Of Hot Tub Folliculitis

Pseudomonas aeruginosa is the bacteria responsible for causing spa rash. It thrives in warm and wet areas thus, a hot tub just happens to be its best breeding spot. Apart from spas and swimming pools, this bacterium is also found in water slides, loofah sponges, whirlpools, and physiotherapy pools.

When Pseudomonas aeruginosa attacks your hot tub, it contaminates the water and when you jump in for a soak, it attaches itself to your hair follicles. You won’t realize the damage it has done on your skin until after a few hours or a couple of days later when you start developing a telltale rash.

Kids are more prone to hot tub rash than adults are, probably because, their skin is quite sensitive and they love spending more time in the water. Other individuals who are more susceptible to this condition include:

  • Anyone whose immune system is compromised due to life-threatening conditions like diabetes, HIV, or leukemia
  • People who have epilated, waxed, or shaved recently
  • Those with dermatitis or acne already as these could make it easier for the bacteria to go through the skin

How thoroughly do you wash and dry your swimsuit before use? This could also be another cause of spa rash. Clean your bathing suit properly after every soak and let it dry completely before putting it on. Also, once you have stepped out of the tub, don’t stay in your swimsuit for too long.


Hot tub folliculitis symptoms include:

  • Red, bumpy, and itchy rash that resembles acne
  • Large white-headed pimples
  • Pus-filled blisters that scar when scratched
  • Lesions that appear on areas that have been exposed to wet bathing suits

Diagnosis And Treatment

Less serious cases of spa folliculitis will resolve on their own in less than two weeks. However, there are various home remedies you can use to speed up the process of healing. The most common ones include:

  • Using warm compresses. These will reduce the burning and hasten the healing.
  • Applying anti-itching lotions and creams to relieve discomfort.
  • Smearing antibacterial creams on the affected areas. This will protect you from other secondary ailments.
  • Immersing yourself in a tub that contains apple cider vinegar or applying the vinegar directly to areas that have been affected by hot tub folliculitis.

If none of these methods seems to work or the infection keeps coming back, then it is time to have a doctor visit. Any qualified dermatologist should be able to pinpoint spa rash even without conducting tests on the patient. They should be able to tell that you have been using a spa just by looking at you.

Your doctor will prescribe some medications to help kick the infection out of your body fully. These could be topical or oral antibiotics or topical antibacterial ointments. If these don’t clear up the infection, then your doctor may decide to take a skin sample to find out the cause.

No bacteria can survive on well-maintained skin so if you have been taking proper care of yourself, the rash will disappear without even the need for you to see a doctor. We have mentioned that you could use some home treatments to hasten the healing process but then it would be wise to see a doctor first before trying anything on your skin.

A good number of us have very sensitive skins and some of the home remedies we use for the rash could make the situation worse than better.

How To Care For The Affected Skin

The worst thing about spa folliculitis is not how the skin looks; it is itching! You want to assume that the rash doesn’t exist but however hard you try, the burning sensation just keeps telling you otherwise.

You keep promising yourself that you won’t scratch but every time you find yourself breaking that promise. Sure, some things are easier said than done but for hot tub folliculitis, you really need to keep your fingers as far away as possible from the itching bumps. It sounds unrealistic, we know, but this is the only way to ensure that the rash doesn’t spread to other parts of the body.

That’s not all. Don’t be tempted to shave the infected parts. Spa rash mostly affects the hair follicles and it’s not unusual for people who have the condition to want to shave with the hope of relieving the itch.

While this may reduce the burning temporarily, the result could be much worse. You may trigger the spread of the bacteria in the process, making the condition more severe than when you hadn’t shaved. So do yourself a favor and keep the shaving machine away.

Possible Complications

We strongly recommend that spa rash be treated as soon as it is spotted. If this condition is not addressed early enough, it could escalate to:

  • Spreading or recurrent infection
  • Boils beneath the skin, commonly known as furunculosis
  • Dark spots, scarring, and permanent skin damage
  • Damage to hair follicles
  • Permanent hair loss


You can soak in a Pseudomonas aeruginosa contaminated hot tub and later hop into a freshwater bathtub to prevent spa rash, right? WRONG! This bacterium takes less than a minute to penetrate your skin and taking an after soak shower won’t get it out.

Instead of going through all this hassle, why don’t you just take care of your spa? Getting your hot tub chemistry right could be a good place to get started. Test your hot tub water frequently to see whether it is balanced or not and how many chemicals you need to put in there.

Technically, this will be determined by the number of hot tub chemicals present in the water. Too much or fewer chemicals will make your system more basic or acidic. Keep these at the appropriate levels and balance the PH of your hot tub if you are serious about saying goodbye to folliculitis. The recommended PH values of a hot tub should be between 7.2 and 7.8. Any reading below or above this range is too basic or too acidic.

But how does PH affect the growth and development of Pseudomonas aeruginosa? You may ask! Simple – a lower or higher PH value than usual affects how the hot tub sanitizers blend with the water. In other words, it reduces the effectiveness of these treatments, providing the perfect conditions for the bacteria to breed.

You should test your spa at least twice a week or any time you have a heavy bather load. You can either do it by yourself or have a professional do it for you. Most modern hot tubs come with a test kit so you can keep track of what is happening in your hot tub. But even though you do this frequently at home, we highly recommend that you take a sample of your spa water to local hot tub dealers for testing once in a while, as these can be able to identify water issues that most home test kits can’t.

The number of people who soak in your spa and how frequently they do this will also determine how often you test your water. The more bathers you have and the more you have your hot tub used, the more exposed you are too hot tub rash. So apart from testing your water regularly, the other effective way to keep pseudomonas aeruginosa away from your skin is to shock your hot tub often.

Pay attention to personal hygiene too. For example, take a shower after soaking sessions, paying close attention to areas beneath your swimsuit and as we mentioned earlier, give your bathing costume a thorough cleaning too so that it doesn’t dry up with the spa water.

Besides, avoid waxing or shaving right before jumping into your spa. Hair removal should be done well in advance before the soak. Shaving damages hair follicles and makes the skin sensitive. This coupled with a dirty hot tub creates the best environment for hot tub folliculitis causing bacteria.

How To Keep Your Contaminated Spa Clean

If you already have folliculitis and your doctor has confirmed that your hot tub is the culprit, discontinue using it right away. This will help you heal faster and prevent others from catching the infection.

We have talked about keeping your water balanced but unfortunately, this alone may not kill all the bacteria. Pseudomonas aeruginosa especially is a sturdy one and will flourish even on your pipes and filters. Your best bet? Draining and cleaning the hot tub! To do this:

  1. Unplug your spa and just to be safe, trip the GFCI breaker. You don’t want your equipment to run without water, as this could damage the hot tub heater and pumps.
  2. Locate your filters and remove them from their wells. Okay, you already know how to clean hot tub filters but this time around, even a chemical soak will not get the job done if the bacteria had already sneaked its way in. You need to get the filters replaced.
  3. Drain your spa until there is no water left.
  4. Get a dilute bleach solution and wipe the interior of your spa. If you are going to use a hot tub cleaner, make sure to rinse it thoroughly as leaving its residue behind will affect the water chemistry.
  5. Replace the filters and refill your hot tub. If you have a hose filter, use it so that you don’t contaminate your water with metals.
  6. Plug your hot tub back into the power outlet and turn it on to start the equipment.
  7. Test the water, balance the PH, and add the sanitizers.
  8. Give your spa a shock dose, set it at the right temperature, and let it run for about 24 hours.
  9. Test your water again to see if any chemicals need adjusting.
  10. And … (drum roll please) your hot tub is safe to soak!

Globo Surf Overview

Hot tub folliculitis is not life-threatening but it is definitely something that every spa owner should be concerned about. Prevention is better and way cheaper than cure so invest in avoiding the infection than in curing it.

The best way to do this is to follow your hot tub maintenance schedule religiously. Test your water regularly and keep it balanced so that it doesn’t become a breeding net for bacteria. Today is a hot tub rush but tomorrow it might be something more dangerous. So stay safe by taking into consideration all the safety measures we have discussed above.

More Hot Tub Reviews:


  1. Folliculitis,
  2. Facts About ‘Hot tub Rash’,
  3. Pseudomonas Folliculitis Treatment & Management,
Globo Surf
My name is David Hamburg. I am an avid water sports fan who enjoys paddle boarding, surfing, scuba diving, and kite surfing. Anything with a board or chance I can get in the water I love! I am such a big fan I decided to start this website to review all my favorite products and some others. Hope you enjoy!