A Mysterious Case of Tummy Pimples

A 17-year-old girl presents with a pruritic rash of 2-3 day's duration. PMH is noncontributory. She recently spent an evening in a hot tub with friends.

Physical exam reveals 0.5-mm papules and pustules located primarily on the trunk; some are inflamed and tender to palpation.

Note tender erythematous papulopustules at her waistline.

Note the inflamed papules. The upper (yellow) arrow shows a punctate pustule.

You see similar tender papules and punctate pustules on upper arm. Note this area was covered by a damp t-shirt during the hot tub immersion.

Close-up of upper arm lesions.

What is your diagnosis? A. Impetigo/staph folliculitis B. Acne C. Bromide hypersensitivity D. Pseudomonas/hot tub folliculitis E. Bad hygiene

Answer: D. Pseudomonas (Hot Tub) Folliculitis.

Common community-acquired skin infection that results from exposure to nonchlorinated water.

Pseudomonas

aeruginosa infection is self-limited; clears spontaneously without treatment; no systemic spread. Resistant to common PO and topical antibiotics. If persistent, treat with course of ciprofloxacin..

2.5% acetic acid (white vinegar) applied topically every 20-30 minutes alleviates the symptoms of itching and/or pain quickly.