Hot Tub Folliculitis

[chem geek]

I got a PM from user "kembel" so am putting this into a thread so the information is made available to all (he wrote that was OK to do so).

Hello Chem Geek, I have been following your chlorine sanitizing method religiously. Can't say I've been perfect but I'm 98% good. Anyway, I believe I have contracted Hot Tub Folliculitis from my hot tub. But I'm confused. I'm very careful not to go into the tub unless there is free chlorine. How could this have happened? Any recommendations? The outbreak is not too bad and it's on the mend. I'm concerned for others. Thanks, Marcus

Hi Marcus,

I'm so sorry you got Hot Tub Folliculitis. Are the symptoms consistent with the column "Rashes caused by a bacterial infection" in this link or are they more like "Rashes caused by a chemical reaction"? You say that you only go in when there is Free Chlorine, but did the FC level get very low or to zero at any point in time in between your soaks? If bacterial biofilms form then having a normal FC level won't get rid of them. The key is to kill the bacteria before they can form biofilms.

Also, some people get rashes from exposure to hot water or to jet pressure. On what part of your body did you get your rashes?

Thanks,

Richard

Chem Geek,

Thanks for the quick reply. Not a rash. I've had an outbreak of hair follicle bumps and 50% of my hair is gone on my legs arms and stomach. Bumps are mostly gone now.

Yes, the FC got to zero for a short time. I added Chlorine made sure the FC was good and hours later I was in.

Tell me more about the biofilm and FC not getting rid of them. How do I combat the film? How do I know I have it?

Thanks so much,

Marcus

How short was "a short time"? Bacteria can double in population in 15 to 60 minutes so it would take some number of hours before they could establish biofilms -- usually 8 or 12 hours before they were substantial enough to prevent chlorine from getting rid of them though more typically problems are seen after 24 hours with no disinfectant. Biofilms are bacterial colonies on surfaces where the bacteria excrete chemicals on the surface that are resistant to chemical attack.

You can often tell if you have biofilm on a surface because the surface will feel slimy. You can get rid of biofilm by using a product such as Ahh-Some®. Superchlorination (to 50 or 100 ppm) can often, but not always, remove biofilm.

If you don't think you'll be able to consistently maintain a chlorine level in the spa, then you might consider supplementing with AquaFinesse which inhibits biofilm formation (it's not a disinfectant by itself).

[PreservedSwine]

Is missing hair a symptom of folliculitis, or is that perhaps over sanitation?

[chem geek]

Folliculitis is an infection of the hair follicles and usually results in a rash that appears like red pimples with the hair in the center of each pimple. As noted in this link,

Folliculitis is a term for inflammation of hair follicles. It looks like acne with little rings of inflammation surrounding the opening of a hair follicle. In the early stages of a folliculitis, the hair fiber may still be present, but as the folliculitis progresses the hair often falls out. When folliculitis is severe, inflammation is so intense that it can permanently destroy the hair follicles, leaving little bald patches.

so hair may fall out with folliculitis.

I presume that Dichlor was used first before using bleach and that the start of the soak was at a lower FC. I don't know of even high FC levels without CYA causing hair to fall out.

[kembel]

It's hard to say how long the FC was zero. But it was hours (one time). Also, I do remember the walls feeling a bit slimy at one time after that. I thought the acrylic was a little slimy because of the recently added Borate (recommended by Nitro for softening the water) so I didn't pay it particular attention, but I did notice it. Tub seems normal now after a zap of high Chlorine over the weekend, but I'm taking no chances. New filters and Nature 2 are here and I'm doing a water change this weekend (water 4-5 months old but always clear).

What sucks.........If I miss just one day checking for FC (say I'm sick) I may contaminate the water, a bit frustrating.

Thanks for all the great advise and links!

Wish me luck on a grow-back......

[chem geek]

Since you don't have an ozonator, missing a chlorine dose for a day shouldn't be a problem since your 24-hour chlorine demand should be around 25% or so in between doses (less if the water temp gets cooler) so a level of 2 ppm isn't going to drop to zero that fast. You will only get to near zero chlorine levels if you aren't adding enough after each soak or are leaving the water unattended for more than a day or two. With an ozonator it's much more likely to get way too low in chlorine since the 24-hour chlorine demand can then be 50% or higher.

Nevertheless, managing a spa using chlorine requires more diligence if you don't have automation (such as a saltwater chlorine generator). That's one reason why some people prefer bromine since you can have bromine tabs in a feeder for dosing in between soaks. Also, for those with ozonators, the ozone can create more bromine from a bromide bank.

One more thing. You say you had the water 4-5 months and still being clear (which is a hallmark of the Dichlor-then-bleach method since it avoids buildup of CYA), but did you add Dichlor about once a month for about 5-6 ppm FC to add back around 5 ppm CYA to the water? CYA slowly gets oxidized by chlorine so you do want to maintain its level. If you don't, then the chlorine will be too strong and it will also dissipate faster which makes its level more difficult to maintain.

I certainly hope your hair grows back soon.

[kembel]

I do add Dichlor when needed. I test for it. What's more impressive is my (and wife) high usage (5 times per week, 40-60 minutes per soak) did not hinder the method's success. I was shooting for 6 months on the water and was confident I'd get there. You did not comment on the use of Bromate. Can you give me any insite? What are your thoughts of a saltwater chlorine generator? I've read about them but not sure they're for me with my high usage.

[chem geek]

The addition of borates shouldn't have affected the feel of the acrylic -- it should not make it slimy. So that feeling was more likely to be biofilm formation when the chlorine got to near zero.

I don't think the saltwater chlorine generator such as the ControlOMatic Technichlor would be able to handle your high bather load by itself, but that wouldn't be the point for getting it. You would still add chlorine after your soak to handle your bather load, but would depend on the chlorine generator to maintain a chlorine level in between soaks. Just remember that some spas aren't designed for the 2000 ppm salt level of the generator. Also, your addition of chlorine after your soak will build up the salt level. In fact, in your situation without an ozonator, if your two people, 40-60 minutes, 5 times a week bather load would be around 58 ppm FC (assuming a 350 gallon spa) added per week to handle the 8-1/3 person-hours per week of bather load. The salt level would increase by around 410 ppm per month so nearly 2500 ppm after 6 months. So even though your water may have remained clear, you'd probably want to change the water to reduce the salt level anyway. And this may be the reason why you couldn't use such a generator with high bather load since you'd increase the salt level much higher (since it will start out close to 2000 ppm for the generator).

I also suspect that if you go months using chlorine, that there is probably a buildup of some slow-to-oxidize organics or even some that don't get oxidized by chlorine at all but that nevertheless are food for bacteria. So it becomes even more important to maintain a chlorine level after a lot of cumulative bather load. In fact, I've been estimating the water change interval at double the standard so roughly (2/9) x (Spa Size in Gallons) / (Person-Hours per Day) so assuming 350 gallons then in your case this would be 65 days so about 2 months. So you were able to go well beyond that estimate and that estimate is double the industry standard formula. There's no way if you were using Dichlor-only that you would have been able to go as long as you did with the water clear.

[kembel]

Understood on the borates. I'll probably not add it this time. Good info on the salt too. My tub size is 370 gallons and a Jacuzzi Model 345. I'm not sure if this model is OK for the auto chlorination. If anyone knows I'd appreciate a little feedback. I think the key was testing for CYA. I actually did not use that much since the CYA target was 20-30ppm. Having a Taylor K-2005 testing kit is key for water management. Would you recommend a change at 3 months regardless of water clarity based on my usage?

[chem geek]

Yes, I think given your high usage that a water change at around 3 months would be reasonable, mostly due to the salt buildup. It partly depends on your spa's ability to resist metal corrosion. I don't have any idea of the quality of stainless steel used in your spa. It's both the higher conductivity from the salt and the higher concentration of chloride that increase metal corrosion of stainless steel. The higher conductivity increases electrochemical corrosion while the higher chloride level inhibits the reformation of the passivity layer in stainless steel. Marine-grade stainless steel (316, 317, 904L) is designed to resist such corrosion compared to more common lower grade stainless steel (304). As shown in this paper, tests of immersion in sodium chloride solutions had 304 grade corrode at 1.2 mpy and with a depth of pitting of 16 mils compared to 316 grade at only 0.1 mpy and with a depth of pitting that was slight.

By the way, the Taylor K-2006 kit is better than the K-2005 because the 2006 has the FAS-DPD chlorine test which is more accurate and doesn't bleach out at high chlorine levels. If you already have the K-2005, you can just get the FAS-DPD chlorine test in the K-1515 kit. For day-to-day chlorine measurement, your DPD test is OK. It's just harder to measure the chlorine accurately. The FAS-DPD test comes in very handy when measuring overnight or 24-hour chlorine loss rates due to its high precision.

[kembel]

Thank you very much for your time, talents and guidance.