The MÖ Aesthetic Clinic

Psoriasis

Doctor Fish and Psoriasis

You may have heard about an unusual treatment for psoriasis which uses a fish called Garra Rufa, more popularly known as Doctor Fish. The fish are placed in a tub or pool together with one or more psoriasis patients whereby the fish approach the patients and consume their dead skin, leaving the healthy skin untouched. Although a widely accepted treatment for a common, chronic, relapsing/remitting, immune-mediated systemic disease, one wonders how safe and effective these treatments are.

Doctor fish are members of the carp family and originate in India, the Middle Asia and in the Central Anatolia region of Turkey. Their natural habitat is in thermal hot springs with temperatures of up to 35°C. There are at least two species of doctor fish - Cyprinion macrostomus and Garra rufa (Cyprinidae), with the latter being the main species of interest.

Garra rufa normally feed on phyto- and zooplankton. However, in the hot pools of Kangal, Turkey where plankton is scarce, these fish feed on and remove the dead skin off of bathers, reportedly leading to improved skin condition for those suffering from disorders such as psoriasis and atopic dermatitis. The fish have a cleansing and healing effect, targeting only diseased skin and dead skin cells, leaving healthy skin untouched. Many people are treated simultaneously in the same pool, where the fish swim from person to person and remove the dead skin.

The treatment is also available in a number of traditional spas, medi-spas, medical centres or skin clinics in Europe, such as in Germany, Switzerland, Austria and Denmark where a patient is treated individually in a pool or tub. Some psoriasis sufferers go to the extent of buying the fish themselves and doing home treatments.

The use of living organisms in medicine is widely in the medical community. This form of treatment includes the use of leeches, maggots, worms and fish. The Federal Drug Administration (FDA) in the USA has approved both leeches and maggots as ‘medical devices’. However, due to the lack of sufficient research supporting the doctor fish phenomenon, there is no such formal government approval for the general use of doctor fish in the USA or Europe to treat psoriasis.

Psoriasis

Psoriasis is one of the most common skin diseases found in most European countries. It has been estimated that the percentage of people with psoriasis within a population increases with the country’s northern latitude . The reason for this is that there is less sunlight, which means less ultraviolet (UV) light and less vitamin D, both of which are used, incidentally, in the conventional treatment of psoriasis.

According to the International Federation of Psoriasis Associations, psoriasis affects about 3% of the world’s population. However, this disease is not equally distributed. The disease is more or less equally divided throughout the population, independent of gender, race or age. About half of those afflicted acquire the symptoms before reaching the age of twenty. Psoriasis is the most common skin disease.

Psoriasis, which is an immune-mediated disease, is not contagious, but it may be based on genetics. Psoriasis causes red, scaly patches (lesions) to appear on the skin. This happens because the immune system causes skin cells to grow too fast. Normally, the skin reproduces itself every 28-30 days, while for those suffering from psoriasis it can be reproduced every three to four days.

Even though there is significant research on the subject, the disease is still not completely understood. There is common agreement that there is no known cure for psoriasis, and the different treatments only have a temporary healing effect for a shorter or longer period of time. The reason that there are number of different types of treatments is that no one treatment is effective for everyone.

There are different types of psoriasis: Vulgaris (Plaque), Guttate, Pustular, Inverse and Erythrodermic. Of these, Vulgaris is generally believed to be the most common. However, there are no statistics providing the number of people afflicted with each of these types.

Academic Research

As a result of comprehensive literature research, two academic papers were found to discuss the use of doctor fish, with one of these having been published on www.pubmed.gov, an acknowledged American website that publishes medical papers.

One paper is written by M. Grassberger and W. Hoch at the Medical University of Vienna, which states that the doctor fish treatment had a positive effect on the majority of a group that was tested. The paper emphasizes that this one study with a limited number (67) of patients tested, is not enough to validate that the treatment actually works, and concludes that additional studies should be performed.

Another research paper presented a study on the effect of using doctor fish as a skin disorder treatment. The study was conducted at the Kangal springs in Turkey, which is the largest treatment facility of this type in Europe. The study’s conclusions supported the findings in the University of Vienna paper.

From a medical point of view, this limited  research is not enough to be called conclusive, and  it will likely take years of research before conclusive results are obtained. It is therefore not concluded that doctor fish have the desired treatment effect on psoriasis, but there is reason to be optimistic, since none of the research reports reviewed to date disprove this. It would take years to obtain approval to use the doctor fish treatment as part of traditional medicine.

Disease Transfer

Some research has been done in the field of the transfer of diseases or infections between patients via doctor fish and the transmission of pathogens (mainly viruses like HIV and HCV) between patients is an issue of concern.

When it comes to the transfer of diseases between humans, there are no known cases from the literature regarding the specific species of fish, Garra Rufa. However, there are some micro-organisms that can be transferred from one person to another due to this treatment. Of course, this threat is largest when one uses one pool with many people at the same time, where one cannot rule out the possibility of pathogens being transferred from one patient to another. Various diseases can also be transferred directly between patients, since there cannot be any chlorine in the water as this would kill the Garra Rufa.

According to the literature there are no known instances where fish have been carriers of a human pathogen virus with the exception when eating raw, or not well cooked or well fried fish. Well-known human pathogens, such as HIV or HBV do not form in fish. If the fish bite a sick patient and the patient starts to bleed, there is a theoretical possibility that the fish can transfer the blood, and thereby the disease, from one patient to another.

In addition to bacteria that can be transferred via food, there are bacteria that can be transferred via fish or water and that can cause health problems in humans. This applies to pathogen bacteria which are found both in humans and fish. Specifically, Mycobacterium marinum, Streptococcus iniae or Salmonella paratyphi B are all human pathogens that will survive in fish. The latter bacteria Salmonella is known to be able to survive in fish for several weeks. At this time, there are no known fish parasites that cause infections in humans.

Whilst available in more and more clinics, the use of Doctor Fish as a treatment option for psoriasis is still in need of research and the possibility of disease transfer between humans via doctor fish cannot be eliminated.  

 


By Marianne Olavesen-Stabb

Norwegian-born Marianne Olavesen-Stabb has been a product designer, trainer and consultant to the international health, wellbeing and beauty Industry for 21 years.

She is the Founder and President of Scandinavian Skincare Systems and was also one of the finalists in Cosmopolitan’s 'Women of Achievement Awards' for her achievements in Health & Wellbeing.

marianne@scandinavianskincaresystems.com

 

 

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