Hot Tub Rash (Folliculitis): After Hot Springs, Hot Tubs and Pools
Itchy red bumps under your swimsuit a day after a hot tub or hot spring are often hot tub folliculitis. Here's what helps, and when to get it checked.
Hot tub rash (hot tub folliculitis) is an infection of the hair follicles caused by bacteria that grow in warm water that isn't well treated. It shows up as itchy, red bumps or small pus-filled pimples, usually 12 to 48 hours after a hot tub, hot spring, pool or water park, and is often worst where a swimsuit held wet water against the skin. Most cases clear up on their own in about a week to 10 days. Get seen if bumps are painful, spreading, turning into boils, or come with a fever.
What it looks like
- Itchy, red bumps around hair follicles
- Small pus-filled pimples or blisters
- Worse under the swimsuit area, on the buttocks, hips, back and thighs
- Sometimes tender skin, and occasionally sore eyes, ears or throat
- Appears 12 to 48 hours after being in the water
Why it happens
The usual cause is a bacterium called Pseudomonas, which survives in warm water when chlorine or bromine levels are low or there are lots of people in the water. Hot temperatures also break down disinfectants faster. It can happen after private hot tubs, hotel and rental spas, hot springs, heated pools, and even inflatable hot tubs.
What helps
- Shower with soap and water right after getting out of a hot tub or pool
- Take off a wet swimsuit right away, and wash it before wearing it again
- Use warm compresses on itchy or tender bumps a few times a day
- Try an anti-itch cream or an oral antihistamine
- Don't shave the area until it heals
- Don't squeeze the bumps
Most cases clear without antibiotics. Some people need prescription treatment if it's severe or not improving.
Hot tub rash or something else?
Itchy bumps after the water can also be swimmer's itch (from parasites in lakes and ponds), hives, heat rash or ordinary folliculitis from shaving or tight clothing. A boil or abscess is larger, deeper and more painful; see our post on cellulitis, abscesses and boils. Ear pain after swimming may be swimmer's ear.
Preventing it
- Use hot tubs that are well maintained, with clear water and a chemical smell that isn't overpowering
- Shower before and after
- Spend less time in the water
- Take off a wet swimsuit soon after getting out
When to get seen
Come in, or start with a telehealth visit, if bumps are painful, spreading, getting larger or turning into boils, or if a rash hasn't improved after a week. At an AfterOurs clinic, a standard self-pay visit is $175, and a self-pay in-clinic visit never costs more than $330. Telehealth is $75. We contract with all major commercial and government plans, including Colorado Medicaid and Medicare. See our rashes page and the cost and insurance page.
Get seen the same day if the skin becomes red, hot and swollen, red streaks spread from the bumps, or a painful lump forms. Go to the ER if that comes with a high fever or chills, or you have a weakened immune system and feel unwell.
Where to find us
Four clinics across metro Denver, all ages welcome, se habla español:
- Hampden (Southeast Denver): 8 AM–11 PM daily
- Littleton: 8 AM–11 PM daily
- Thornton: 8 AM–11 PM daily
- Highlands: Mon–Fri 5–11 PM, Sat–Sun 8 AM–11 PM
Walk in, or book online.
Medically reviewed by Peter Martinuzzi, MD
This article is general health information, not medical advice for your situation. If you are worried, come in or book a telehealth visit — and if it is an emergency, call 911.