A few days after a homecoming party a 17-year-old girl presents with a pruritic rash at her waist and on her upper arms. What went on?
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.
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.
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.
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.
The slides above provide a close look at the itchy eruption on a teenage girl's trunk. Is this something you have seen before? What's your diagnosis?