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Pseudomonas Folliculitis Clinical Presentation

  • Author: Charles B Toner, MD; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Nov 19, 2015
 

History

Pseudomonas folliculitis is characterized by a rash, described as a dermatitis or a folliculitis. The rash onset is usually 48 hours (range, 8 h to 5 d) after exposure to contaminated water, but it can occur as long as 14 days after exposure.[16]

Lesions begin as pruritic, erythematous macules that progress to papules and pustules. Lesions are most prevalent in intertriginous areas or under bathing suits. The rash usually clears spontaneously in 2-10 days, rarely recurs, and heals without scarring, but it may cause desquamation or leave hyperpigmented macules.

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Physical

The predominant manifestation of Pseudomonas folliculitis is dermatitis (79%).

Pseudomonas folliculitis is characterized by follicular papules, vesicles, and pustules, which may be crusted. Lesions involve exposed skin, but they usually spare the face, the neck, the soles, and the palms. Lesions progress to erythematous papulopustules that range in size from 2-10 mm in diameter, with a pinpoint central pustule. The rash is not unique in appearance and is most often confused with insect bites. See the images below.

Erythematous papulopustules of pseudomonas follicuErythematous papulopustules of pseudomonas folliculitis. Courtesy of Mark Welch, MD.
Erythematous papulopustules of pseudomonas follicuErythematous papulopustules of pseudomonas folliculitis, with significant perilesional flare. Courtesy of Andy Montemarano, MD.
Pseudomonas folliculitis. Courtesy of Hon Pak, MD.Pseudomonas folliculitis. Courtesy of Hon Pak, MD.

Other systemic signs of Pseudomonas folliculitis that can occur with the rash include the following:

  • Low-grade fever (4%), often accompanied by headache (15%) and malaise/fatigue (19%)
  • Otitis media and otitis externa[17]
  • Breast tenderness in both women and men (The glands of Montgomery on the nipple may become infected or may involve frank mastitis [11%].)
  • Painful lymphadenopathy
  • Conjunctivitis
  • Rhinitis
  • Pneumonia (rare)
  • Urinary tract infection (UTI) (rare)[18]

Rarely, lesions may progress to chronically draining subcutaneous nodules.

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Causes

The following 3 primary environmental conditions are known to be associated with outbreaks of Pseudomonas folliculitis[19, 20, 21] :

  • Prolonged water exposure
  • Excessive numbers of bathers
  • Inadequate pool or hot tub care[21, 22, 23]

Risk factors for Pseudomonas folliculitis include the following[24] :

  • Crowding
  • Youth
  • Wearing of snug bathing suits
  • Frequency and duration of exposure

Pseudomonas folliculitis outbreaks have been associated with waterslides and similar water attractions.[25] Superchlorinated water has been advised to decrease the incidence of outbreaks. Inflatable pool toys have also been implicated as a source of infection.[26]

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Contributor Information and Disclosures
Author

Charles B Toner, MD Assistant Professor, Department of Dermatology, Uniformed Services University of the Health Sciences, F Edward Hebert School of Medicine; Mohs Surgeon, Skin Cancer Surgery Center; Mohs Surgeon, Charles County Dermatology; Mohs Surgeon, Georgia Dermatology and Skin Cancer Center

Charles B Toner, MD is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Surgery, Association of Military Surgeons of the US, Association of Military Dermatologists, American Medical Association, American Society for Dermatologic Surgery

Disclosure: Nothing to disclose.

Coauthor(s)

Stephen J Krivda, MD Assistant Professor of Dermatology, Uniformed Services University of the Health Sciences; Chief of the Integrated Department of Dermatology, Chief of Dermatology Service, Director of Dermatopathology, Staff Dermatopathologist, Walter Reed Army Medical Center; Head, Department of Dermatology, Staff Dermatologist and Dermatopathologist, National Naval Medical Center

Stephen J Krivda, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, American Society of Dermatopathology, Phi Beta Kappa

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael J Wells, MD, FAAD Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

Lester F Libow, MD Dermatopathologist, South Texas Dermatopathology Laboratory

Lester F Libow, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, Texas Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Leonard Sperling, MD Chair, Professor, Department of Dermatology, Uniformed Services University of the Health Sciences

Leonard Sperling, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References
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  18. Ratnam S, Hogan K, March SB, Butler RW. Whirlpool-associated folliculitis caused by Pseudomonas aeruginosa: report of an outbreak and review. J Clin Microbiol. 1986 Mar. 23(3):655-9. [Medline].

  19. Evans MR, Wilkinson EJ, Jones R, Mathias K, Lenartowicz P. Presumed Pseudomonas folliculitis outbreak in children following an outdoor games event. Commun Dis Public Health. 2003 Apr. 6(1):18-21. [Medline].

  20. Fox AB, Hambrick GW Jr. Recreationally associated Pseudomonas aeruginosa folliculitis. Report of an epidemic. Arch Dermatol. 1984 Oct. 120(10):1304-7. [Medline].

  21. Yu Y, Cheng AS, Wang L, Dunne WM, Bayliss SJ. Hot tub folliculitis or hot hand-foot syndrome caused by Pseudomonas aeruginosa. J Am Acad Dermatol. 2007 Oct. 57(4):596-600. [Medline].

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Erythematous papulopustules of pseudomonas folliculitis. Courtesy of Mark Welch, MD.
Erythematous papulopustules of pseudomonas folliculitis, with significant perilesional flare. Courtesy of Andy Montemarano, MD.
Pseudomonas folliculitis. Courtesy of Hon Pak, MD.
 
 
 
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