Foot-Nibbling Garra Rufa Fish

Risks and Health Benefits of Turkish "Doctor Fish" Spas

Sep 29, 2009 Susan Cunningham

As the fish spa fad races through Asia, medical claims are exaggerated and dangers downplayed. And how to tell if the doctor fish are genuine Garra rufa?

People with psoriasis and other skin disorders have for decades flocked to outdoor hot springs near Kangal, Turkey, where the minnow-like Garra rufa fish naturally breed and feed. The species of carp, which have no teeth, painlessly nibble away humans' dead skin.

In 2006, the inch-long fish, sometimes called reddish log suckers, started turning up in hot springs in Japan and Croatia. Soon the fish were being imported by China, South Korea, Belgium and the Netherlands. Next, inexpensive “fish foot therapy” was being offered in shopping malls and department stores in Japan, South Korea and Singapore. Now the fish spas are spreading throughout Southeast Asia, although Kuala Lumpur seems to have the most.

The pedicure should be painless. Customers dunk their feet into a long fish tank or individual plastic basins filled with warm water. Immediately the feet are enveloped by hundreds of the silvery orange-tinged Garra rufa, also known as nibble fish, kangal fish, little dermatologists, doctor fish and doctorfishen. Searching YouTube with the words “fish spa” will turn up some examples of the tanks and fish.

Treatment for Psoriasis and Callouses

The fish masseurs gently suck the skin. The feeling is ticklish, even pleasant, though it can take a few minutes to get used to. If the feeling resembles a pin prick, it's probably caused by tiny teeth and the fish aren't genuine Garra rufa. In Southeast Asia, the fakes are most likely a much cheaper Chinese import, a species of carp called chin chin. One way to identify genuine Garra rufa fish: unlike schools of chin chin, Garra rufa cluster in the bottom of the tank when there isn't human skin available to chew. There are other Garra rufa imposters out there. Nile tilapia, larger than Garra rufa, is another common fake cropping up in Southeast Asian fish spas.

Although fish-eating treatments have a fancy name--ichthyotheraphy--there is very little scientific evidence to back up claims that the saliva of Garra rufa fish leave behind a potent enzyme that, with repeated treatments, can cure psoriasis and eczema. But by peeling away ordinary callouses and the thick lesions of psoriasis, the fish do leave feet feeling softer and prettier.

Fish Foot Spa Risks

Even the inexpensive Malaysian spas described here look very clean and require customers to wash their feet in antiseptic baths before dipping their feet. The water is constantly filtered.

The question remains, though, could a customer catch a skin infection from another customer? Or from the fish themselves? In Asia, the spas commonly respond that they use UHF rays to kill bacteria in the water. Even assuming that works, what about fungi (which aren't bacteria) from feet or fish?

Since 2008 health departments in more than a dozen US states have ruled there was a risk and banned the treatments. That's around the same time the always cautious Singapore government shut down several spas. (Ironically, Kenko, a franchiser of Garra rufa spas in Southeast Asia, is based in Singapore.)

Based on local news reports, Washington and Texas beauty salons where the service was offered also seemed to be taking more cautious measures than the group pools commonly seen in Southeast Asia. These U.S. spas were using individual basins for each customer and sterilizing them after each use. Nonetheless, it wasn't enough for the sanitation police. A spokeswoman for Washington's Department of Licensing explained, "You can clean the tank, you can clean the water, but there's no guarantee that the fish aren't carrying something from the previous customer."

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