Tuesday, October 3, 2023

Are fish pedicures safe?

A case reported in the journal JAMA Dermatology in July 2018 spoke about a woman who underwent fish pedicure and ended up losing her toenails. Following this, it became a medical topic of discussion. The media latched on to it proclaiming how foot spas could spread HIV and hepatitis. So are fish pedicures safe, or not?

What is a fish pedicure?

A fish pedicure uses tiny Garra Rufa fish to nibble away dead skin from the feet of the patron for 15 to 30 minutes. The person puts his feet in a tank of warm water containing such fish. These freshwater fish are native to the waters of Iraq, Israel, Jordan, Turkey and Syria.

These carp fish, also called Doctor Fish, normally eat plankton. They are omnivores, and if they don’t get enough food, they will eat human skin. They are toothless and so they can only nibble away, but not bite into, the hardened skin.

A 4–minute video from YouTube shows below the typical fish spa and how fish pedicure is done.

A YouTube video of a visit to a fish spa to learn about Fish Spa Therapy

Various media and other reports

A 2006 paper in the journal Evidence-Based Complementary and Alternative Medicine showed that food pedicure could be used to improve the symptoms of psoriasis. These fish ate the psoriatic plaques and spared normal human skin. In fact, this made a town called Kangal, in Turkey, famous with psoriasis patients.

In Feb 2011, there was a breakout of infection in fish pedicure spas across the United Kingdom.

In 2012, the Center for Disease Control and Prevention (CDC), U.S.A. said that it did not know of any published reports of illnesses from fish pedicures. It also gave reasons why various states in the USA have banned fish pedicure, none of which were directly related to the spread of infection. Some of the reasons were:

  • The fish pedicure tubs are never cleaned between customers
  • The fish cannot be disinfected between customers, obviously
  • The fish generally eat plankton. They need to starved to make them eat human skin. This created an animal cruelty issue.
  • The fish were not native to the USA. So they could harm the local flora and fauna, if released in the wild.
  • The Chinese introduced another species of fish called Chin Chin, in place of Garra Rufa. However, these cannibalistic fish have teeth. So, they can peel the skin instead of nibbling at it. This can cause bleeding and increase the risk of infection.


National Health Services (NHS), U.K., has a comprehensive write-up on fish pedicure risk. It quotes the study by Health Protection Agency (HPA), U.K., which found that the risk would arise only if infected blood from one person would reach another person using the same fish tank. However, given the diluting effect of the tank water, the risk was very low.

HPA recommends that certain groups of people, who either are at a risk of catching infection, or causing infection, should not have a fish pedicure. This includes people who:

  • are diabetic (which leads to increased risk of infection)
  • have psoriasis, eczema or dermatitis affecting the lower legs
  • have a blood-borne virus such as hepatitis B, hepatitis C or HIV
  • have any open cuts, wounds, or broken skin on the lower legs
  • have an infection on the feet, such as athlete’s foot
  • have low immunity due to medication or illness
  • have waxed or shaved their legs (which can cause tiny cuts) in the previous 24 hours
  • have bleeding disorders or are taking anti-coagulant medications

In conclusion

If you are suffering from any condition that risks catching infection, stay away.
If you have some injury or cut to the lower leg or foot, stay away.
Check if the spa follows basic standards of hygiene, such as asking you to wash feet before putting them in the tank.

First published on: 18th November, 2018


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