'Hot tub folliculitis'. Test the waters--and the patient--for Pseudomonas

A healthy 10-year-old boy presented with a widespread, nonpruritic, pustular rash of 3 days' duration. He reported having no fever, chills, or other systemic symptoms. Physical examination revealed perifollicular pustules concentrated in the swimsuit area, with fewer widely scattered lesions on the trunk and extremities (figure 1). His mother reported that he had bathed in a hot tub on the evening before onset of the rash. A similar rash had developed in two other boys who had bathed with the patient. No laboratory tests or cultures were performed. The patient was empirically treated with erythromycin tablets, 250 mg twice daily for 10 days. His mother was instructed to contact the owners of the hot tub so that it could be properly cleaned and maintained. Within 1 week the rash had completely resolved.