Dermatology Book

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Pseudomonas Folliculitis

Aka: Pseudomonas Folliculitis, Hot Tub Folliculitis
  1. See Also
    1. Deep Folliculitis
  2. Etiology: Pseudomonas aeruginosa contaminated water
    1. Whirpool or hot tub
    2. Contaminated loofah sponge
    3. Contaminated diving suit
    4. Waterslide or small pool
  3. 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
  4. 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
  5. Course
    1. Resolves within 7-10 days
    2. May recur within first 3 months
  6. 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
  7. 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
  8. 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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