Pseudomonas folliculitis L08.8

Authors: Prof. Dr. med. Peter Altmeyer, Fabian Müller

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Last updated on: 29.10.2020

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Synonym(s)

Hot-tub dermatitis; Hot tub dermatitis (e); Jacuzzidermatitis; Swimming pool dermatitis; Whirlpool dermatitis

History
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Mc Causland 1976

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

Pathogen
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Especially Pseudomonas aeruginosa. Pseudomonas spp. can persist as a water germ in water pipes, especially in hot water boilers or in whirlpools (whirlpool dermatitis).

Etiopathogenesis
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Risk factors are high water temperature, water turbulence with air admixture, low chlorine content or resistance of the pathogen to chlorine.

Clinical features
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Itchy maculopapular exanthema emphasizing the lateral trunk with follicularly bound red papules and partly pustules. Association with fever, pharyngitis, conjunctivitis, mastitis and axillary lymphadenopathy (bacterial toxin effect). More rare is the simultaneous occurrence of painful papules and nodules on the palms of the hands and/or soles of the feet (whirlpool dermatitis with "hot hands/feets - see also Hot-Foot-Syndrome).

Differential diagnosis
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scabies; prurigo simplex subacuta; pyoderma; varicella and other viral exanthema.

General therapy
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Spontaneous healing after 10-14 days. Systemic antibiotics and local antiseptics do not seem to influence the exanthema.

External therapy
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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%).

Internal therapy
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If spontaneous healing does not occur or if external measures are not sufficient, use Ciprofloxacin (e.g. Ciprobay) 2 times/day 250 mg p.o.

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

Alternatively (e.g. in case of penicillin allergy): Tobramycin (e.g. Gernebcin) Adults 3-5 mg/kg bw/day i.m. or i.v. distributed over 3 ED (30-60 min. short infusions). Children: 5-7 mg/kg bw/day i.m. or i.v., distributed over 3-4 ED.

Progression/forecast
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Spontaneous healing after 10-14 days.

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

Case report(s)
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A 35-year-old man, who was complaining of great stress, noticed a sudden itchy rash on his torso. At the same time slight discomfort, pulling of the chest muscles ("like sore muscles", painful knot in the right axilla.

Findings: On the shoulder, upper arms and on the front of the trunk highly red maculopapular exanthema with follicularly bound red papules and few pustules. On the right side dolent axillary lymphadenopathy.

Smear Pustule: abundant Pseudomonas aeruginosa, also Staphylococcus aureus.

On request: New Year's Eve holiday together with 2 friends. Use of the hotel's own whirlpool. 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.

Literature
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  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

Disclaimer

Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

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Last updated on: 29.10.2020