Hot tubs and whirlpools are becoming more and more popular in many facilities such as leisure centers, hotels and especially in private homes. A bath in the whirlpool can be not only very relaxing, but also good for health – so the warm water provides better blood circulation and massage serves to relax the muscles. However, insufficient hygiene measures can lead to dermatological disease patterns: These include, among others, whirlpool dermatitis.

What is whirlpool dermatitis?

The term whirlpool dermatitis refers to an infectious disease of the skin. This is caused by contact with Pseudomonas-contaminated water, for example in whirlpools. The whirlpool dermatitis is also known as Pseudomonas folliculitis or hot-tub dermatitis.

What are the causes of whirlpool dermatitis?

Most often, whirlpool dermatitis is caused by the bacterium Pseudomonas aeruginosa. Pseudomonads persist in the spa’s many invisible water lines, forming firmly attached biofilm.

Risk factors for infection are:

  • High water temperature
  • Water turbulence with air submixtures
  • Low chlorine content of the water or resistance of the pathogen to chlorine.

Especially in publicly and privately used whirlpools, but also in conventional swimming pools, hot tubs and physiotherapy facilities, whirlpool dermatitis can occur – because at temperatures above 30 degrees Celsius, the triggering bacterium Pseudomonas aeruginosa feels particularly comfortable. The heat and moisture further weaken the skin barrier, providing ideal conditions for the bacterium to penetrate. In addition, the disinfecting chlorine is degraded at water temperatures above 30 degrees Celsius. As a result, a spa that has not been adequately disinfected presents a particularly high risk of infection.

Whirlpool dermatitis is usually more common in children than in adults. In addition, the likelihood of infection increases with longer bathing time. Since Pseudomonas aeruginosa can also occur in hot water boilers, there is also the possibility of infection in one’s own bathtub in rarer cases.

Good to know:
Pseudomonas aeruginosa is a human pathogenic rod-shaped bacterium of the genus Pseudomonas. Due to its extraordinary undemanding nature with respect to living conditions, the bacterium is able to survive for a long time in both humid and dry environments (to only a small extent). In addition to hot tubs, transmission can occur through sinks, bath water, contaminated cosmetics, soft contact lenses, humidifiers, and other moist media. With approximately 10% of all hospital infections, pseudomonads are among the most common hospital germs in Germany. Pseudomonads can cause conditions including pneumonia, urinary tract infections, skin infections, eye and ear infections, and neonatal infections.

What are the symptoms of whirlpool dermatitis?

Hot tub dermatitis occurs after an incubation period of eight to 72 hours after bathing in a bacterially contaminated hot tub, although longer incubation periods of up to eight days have sometimes been observed. It is manifested by itchy exanthema (rash) in the form of red spots, pustules, and papules, especially truncal, on the lateral chest wall, as well as painful swelling of the mammary glands, sore throat and ears, or conjunctivitis. In some cases, general symptoms such as fever, nausea and lymphadenopathy may occur.

What preventive measures can be taken to prevent infection?

Whirlpool folliculitis usually heals without consequences after one to two weeks without special treatment. Thus, no uniform therapy recommendation exists. To prevent disease recurrence or infection, adequate chemical treatment of the water and careful water quality controls must be in place. Automatic water filtration and checking chlorine and disinfectant levels are recommended. In case of increased visitor frequency, the water should be completely changed more frequently. In addition, in the case of contamination with Pseudomonas aeruginosa, over-chlorination of the water (>5 mg/l) for at least 72 hours is also recommended, but this is rarely successful. This is because the biofilm, which continuously builds up in secret, cannot be prevented, nor removed, by the application of disinfectant. But BrilliantPOOL helps here.

Illustrations may differ from the deviate from the original.

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