Can you make the diagnosis?

Sarah is on vacation at the beach, and having a great time with her friends.  They have a great seafood meal at their resort restaurant, then they have a glass of wine in the hot tub.

That night in her hotel room though Sarah starts to feel itchy, and can’t get back to sleep.  She finally gets out of bed and looks at her skin in the bathroom mirror:

hot tub

What does Sarah have?

  1.  Allergic reaction from seafood
  2.  Hot tub folliculitis
  3.  Reaction from drinking alcohol
  4.  Bedbugs



If you guessed 2.  Hot tub folliculitis, you are right!

Hot tub folliculitis is a skin infection of the hair follicles, and is caused by water that is contaminated with bacteria. Children tend to be affected more often than adults. It can also occur from other sources such as pools or water parks.

The infection can begin a few hours to days after being exposed to contaminated water. It begins as an eruption of itchy, red bumps.  The rash may be worse in the areas where the swimsuit contacted the skin.   

Hot tub folliculitis typically resolves without any treatment within 5-10 days. Topical treatments that can be helpful include silver sulfadiazine cream or white vinegar applied to the rash. Oral antibiotics can be used for 5-10 days if the rash is severe. 

An allergic reaction is a possibility, but that rash looks more like hives typically.  Patients with a reaction from drinking alcohol usually have other symptoms such as vomiting and stomach pain.  Bedbug bites create itchy welts in a zig zag pattern.

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