Ichthyotherapy for psoriasis - Your help needed?

Printer-friendly version

Can you help us?

In response to recent enquiries to our helpline we are gathering data about the use of the ‘Doctor Fish of Kangal’ or ichthyotherapy.


The ‘Doctor Fish of Kangal’ are Garra Rufa or Red Barb fish and belong to the carp family and are found in the Kangal Springs in Sivas, Turkey. The springs were a kind of reed-bed until 1917, when by chance a shepherd who was wounded on his foot saw his wound healed by the water of the spring.

This fact got the attention of the public and primitive pools were built in the late 1950s. In 1960s the springs were taken over, by the local administration of Sivas and several lodgings facilities were built.

The springs were put out to tender in 1996 by the local administration for a long-term operation contract. The area is now a modern therapy centre for psoriasis.

UK walk-in pedicure therapy

In the UK there has been recent publicity about the use of fish that nibble the feet in a ‘spa’ setting; these are often located within shopping centres. The benefits claimed by some of the outlets include the treatment of psoriasis.

As an organisation that is evidence driven we have been searching for robust data that backs-up these claims in order that you as a person with psoriasis can make an informed choice regarding the validity and safety of using such therapies.

Expert comments

After speaking to various experts, the only research that appears to have been published is an article called Ichthyotherapy as Alternative Treatment for Patients with Psoriasis: A Pilot Study (reference 1) . The following statement has been put together to assist you with regard to the research of psoriasis and Garra Rufa fish:

“We have reviewed the trial published and whilst the results appear to be promising, these should be interpreted with caution. This was an open, retrospective evaluation of the treatment so there is no control group - i.e. it is difficult to be certain that the beneficial effect is due to the treatment, or whether it is a so-called placebo response, or just spontaneous resolution. Secondly, the fish treatment is given with UVA - which may also be contributing to the therapeutic effect. Finally, the data on outcome was retrospectively documented, which automatically introduces potential bias (e.g. it is possible that only those patients finding it helpful continued, and therefore these were the only patients on whom data was available to report on).

In summary, this paper may indicate promise but there are significant methodological limitations to the study that make it difficult to reach firm conclusions on efficacy or safety.”

The last point in this statement should be specifically considered as safety has not been established, therefore you should proceed with caution as one expert we consulted did have concerns about potential infections that may arise from contaminated water or less than hygenic premises.

News update

There have been reports from various media outlets including the BBC, The Press Association and Reuters about the safety of fish spa treatments and the following appeared on Reuters website on 1 March 2011:

''…Officials at Britain's Health Protection Agency (HPA) said they were launching an investigation into possible infection risks associated with the exfoliation treatment after receiving enquiries from local environmental health officers.

The HPA said it would assess all of the latest evidence on risks before issuing guidelines for the spa treatment.

"The HPA and Health Protection Scotland is currently unaware of any cases of infection associated with the use of the fish spas pedicures in the UK," a spokesman said.

Fish spa pedicures have already been banned in some U.S. states for health and safety reasons…''

Your help needed

  • Have you used fish therapy?
  • What was your experience?
  • What were you told about the therapy?
  • Was the experience good or bad?

You can let us know your experience, views or any information you have by emailing us at: info@papaa.org or registered users once logged-in can use the 'add comment' facility at the bottom of this article.

Notes and references:

Reference 1 eCAM 2006;3(4) 483-488 doi:10.1093/ecam/ne1033 Ichthyotherapy as alternative treatment for psoriasis: A pilot study.
M. Grassberger & W. Hoch - Medical University of Vienna, Austria

The background data for this article was previously published in Skin ‘n’ Bones Connection 2001; issue 15; page 15. ISSN:1457-4134. Which in turn was an abridged version of an article by Dr Levent Undar.

About the Health Protection Agency

The Health Protection Agency is an independent UK organisation that was set up by the government in 2003 to protect the public from threats to their health from infectious diseases and environmental hazards. It does this by providing advice and information to the general public, to health professionals such as doctors and nurses, and to national and local government. www. hpa .org.uk

11 February 2011
28 February 2011
2 March 2011