What is the pathophysiology of Pseudomonas folliculitis (hot tub folliculitis)?

Updated: Oct 02, 2020
  • Author: Charles B Toner, MD; Chief Editor: Dirk M Elston, MD  more...
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The ubiquitous gram-negative bacterial organism, P aeruginosa, found in soil and fresh water, gains entry through hair follicles or via breaks in the skin. Bacterial serotype O:11 is the most commonly reported isolate for water-associated Pseudomonas folliculitis, but other serotypes that have been reported include O:1, O:3, O:4, O:6, O:7, O:9, O:10, and O:16. Serotype O:11 is possibly more invasive or better adapted to survive in halogenated water.

Minor trauma from wax depilation or vigorous rubbing with sponges may facilitate the entry of organisms into the skin, and a dose-response relationship exists in relation to the degree of water contamination. [11, 12, 16, 17] Hot water, high pH (>7.8), and low chlorine level (< 0.5 mg/L) all predispose to infection.

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