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).

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).

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, 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.

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 shoulder, upper arms and front of the trunk, bright red, maculopapular exanthema with follicularly bound red papules and few pustules. Dolente axillary lymphadenopathy on the right side.

Smear pustule: abundant Pseudomonas aeruginosa, also Staphylococcus aureus.

On inquiry: New Year's vacation together with 2 friends. Use of an 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