Pseudomonas folliculitis L08.8

Mc Causland 1976

Harmless infectious disease of the skin originally described in the USA, now occurring worldwide, occurring 8-48 hours after bathing in warm water contaminated with Pseudomonas spp. The disease occurs more frequently in the cold season (note: this is probably related to the increased use of warm communal bathrooms in winter).

Severely itchy, follicularly accentuated, maculopapular, also pustular dermatitis with emphasis on the trunk and here especially the lateral sections of the thorax.

Association with fever, pharyngitis, conjunctivitis, mastitis (painful) and painful axillary lymphadenopathy (bacterial toxin effect), nausea and vomiting.

Less common is the simultaneous occurrence of painful papules and nodules on the palms of the hands and/or soles of the feet (whirl-pool dermatitis with "hot hands/feet - see also hot foot syndrome).

Scabies: evidence of the characteristic ganglionic structures

Prurigo simplex subacuta: Eminently chronic, polyetiologic, endogenously triggered, often accompanied by intolerable itching 0or also painful itching, papular, inflammatory disease of the skin with typical, disseminated, symmetrical distribution pattern.

Varicella and other viral exanthema: acute onset with involvement of oral mucosa and capillitium. Mostly endemic distribution.

Non-tuberculous mycobacteriosis (e.g., M. intermedium): M. intermedium can be transmitted by contaminated water from hot tubs and causes granulomatous dermatitis (see Fig.).

Good effects were reported with a 0.2% gentamicin lotio (0.2% gentamicin in lotio alba aquosa). Alternatively 0.1% gentamicin cream(Refobacin® or as formulation: gentamicin cream 0.1%).

If spontaneous healing does not occur, or if external measures are not sufficient, it is recommended to use ciprofloxacin (e.g. Ciprobay) 250 mg p.o. 2 times/day.

In severe cases, ceftazidime (e.g., Fortum) 2-3 times/day 1-2 g i.v.

Alternatively (e.g., in penicillin allergy): Tobramycin (e.g., Gernebcin) adults 3-5 mg/kg bw/day i.m. or i.v. divided into 3 EDs (30-60 min short infusions). Children: 5-7 mg/kg bw/day i.m. or i.v. divided into 3-4 ED.

Spontaneous healing after 10-14 days. Septic complications are rare.

Through whirlpool baths other infections can be transmitted, even if rarely, e.g. atypical mycobacteria.

A 35-year-old man complaining of great stress noticed a sudden itchy rash on the trunk. At the same time, slight malaise, pulling of the chest muscles ("like sore muscles"), painful lump in the right axilla.

Findings: On the shoulders, upper arms and front of the trunk, highly red, maculopapular dermatitis with follicularly bound red papules and few pustules. Right-sided dolled axillary lymphadenopathy.

Smear pustule: abundant Pseudomonas aeruginosa, also Staphylococcus aureus.

On inquiry: New Year's vacation together with 2 friends. Use of the in-house hot tub. Skin symptoms 2 days later.

Therapy: Ciprofloxacin 2 times/day 250 mg p.o. for 5 days and external application of a 0.2% gentamicin lotio for 5 days.

1. Berrouane YF (2000) Outbreak of severe Pseudomonas aeruginosa infections caused by a contaminated drain in a whirlpool bathtub. Clin Infect Dis 31: 1331-1337
2. Edson RS et al (2006) Mycobacterium intermedium granulomatous dermatitis from hot tub exposure. Emerg Infect Dis 12: 821-3
3. Schirren CG et al (1992) Whirlpool dermatitis: A new epidemic recreational dermatosis. Dt Ärztebl 89: 1756-1758

4. Silverman AR et al (1983) Hot tub dermatitis: a familial outbreak of Pseudomonas folliculitis. J Am Acad Dermatol 8:153-156

5. Yu Y et al (2007) Hot tub folliculitis or hot hand-foot syndrome caused by Pseudomonas aeruginosa. J Am Acad Dermatol 57:596-600