II. Etiology: Pseudomonas aeruginosa contaminated water

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

III. 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

IV. 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

V. Course

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

VI. 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

VII. 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

VIII. 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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