An adolescent with hot-tub folliculitis should be managed as follows. Which choice is most appropriate?

An adolescent with hot-tub folliculitis should be managed as follows. Which choice is most appropriate?

• A. Culture lesions and treat with IM antibiotics.
• B. Prescribe topical keratolytics and topical antibiotics.
• C. Hospitalize for incision and drainage and IV antibiotics.
• D. Order an antistaphylococcal beta-lactamase-resistant antibiotic.

Answer: (B)

Hot-tub folliculitis is a superficial infection of hair follicles caused by Pseudomonas aeruginosa after exposure to poorly chlorinated hot tub water. In healthy adolescents, it usually presents as pruritic, localized papules or vesicles and tends to be self-limited. The best approach targets the surface infection and follicular inflammation without systemic therapy. A keratolytic helps dissolve keratin buildup within the follicle, making it easier for topical medications to reach the bacteria. Pairing this with a topical antibiotic reduces bacterial load at the follicle openings and accelerates resolution without the need for systemic drugs. This approach avoids unnecessary culture, intramuscular or intravenous antibiotics, and hospitalization, which are not needed for mild, localized disease. If symptoms worsen or systemic signs develop, reassessment is needed and management can be escalated accordingly. Also, emphasize avoiding hot tubs or ensuring proper chlorine levels to prevent recurrence.

Hot-tub folliculitis is a superficial infection of hair follicles caused by Pseudomonas aeruginosa after exposure to poorly chlorinated hot tub water. In healthy adolescents, it usually presents as pruritic, localized papules or vesicles and tends to be self-limited. The best approach targets the surface infection and follicular inflammation without systemic therapy. A keratolytic helps dissolve keratin buildup within the follicle, making it easier for topical medications to reach the bacteria. Pairing this with a topical antibiotic reduces bacterial load at the follicle openings and accelerates resolution without the need for systemic drugs. This approach avoids unnecessary culture, intramuscular or intravenous antibiotics, and hospitalization, which are not needed for mild, localized disease. If symptoms worsen or systemic signs develop, reassessment is needed and management can be escalated accordingly. Also, emphasize avoiding hot tubs or ensuring proper chlorine levels to prevent recurrence.