Garra Rufa fish

Doctor Fish Spa

What are these fish?

The scientific name for these amazing silvery-orange fish is garra rufa. Some just call them reddish log suckers or suckermouths, but many people are a bit more affectionate, referring to them as "Doctor Fish" due to their therapeutic effect on skin conditions such as psoriasis, eczema and neurodermatitis. At first glance these fish do not look very remarkable, but wait till they open their mouths!

The "Dr. Fish" are a freshwater fish that belong to the Cyprinidae family (their bigger brothers are carp) and normally inhabit the waterways of the Tigris-Euphrates basin in the Middle East. They have a toothless, crescent-shaped mouth and usually grow to around 12cm in length. These fish normally eat algae, detritus, zooplankton and other bits-and-pieces on the seabed. However, under the right conditions, they also feed on dead and scabby skin!

What does this mean? For people with normal skin, this means some heavy-duty exfoliation or a great pedicure, but for people with psoriasis, it can mean much more. The plaques that are characteristic of psoriasis are like banquet tables for these voracious fish! They love feasting on dead epidermis, and after they're full, there is room for new, healthy skin to grow.

Bon appetit little fish!

The garra rufa fish treatment first became popular around the outdoor hotsprings of two small towns in Turkey called Kangal and Sivas, where the first pools were opened to the public in 1963. The high temperature of the water means that there are practically no microorganisms for the fish to eat, so they go for the next best thing - dead, crusty, scabby skin! After the skin has been softened by the warm spa waters, which are kept around 35°C / 95°F, they have no difficulty in munching it off.

Doesn't it hurt?? The feeling of the nibbling fish is slightly ticklish, like having thousands of miniature suction plugs on your skin, and has actually been likened to a pleasurable micromassage. Once you step in, hundreds of garra rufa will swarm around your entire body in an attempt to find that most tastiest of snacks, the psoriatic plaque! The treatment in Kangal demands that you spend 8 hours a day for a period of 21 days in the pool, so when you emerge at the end, you can bet that all that hyperkeratinized skin you had is inside the bellies of those garra rufa. However, this is not a permanent cure. Many people experience remission, or temporary clearance, that can last anywhere from a few months to a year, but sooner or later, you will need to feed the fish again.

This all sounds pretty fishy. What are the risks?

The idea of slipping inside a pool with fish that swim from person to person, sucking on skin here and there, can be a bit disconcerting. The fish themselves can be hard to sanitize, and 14 states in America, including Washington, New Hampshire and Texas, have banned them. However, the majority haven't, and they are also legal in the UK. Many spas treat the water with Ultral Violet Sterilizers to kill the bacteria, and have complex filtering systems to keep the water free from fish waste and food.

The chance of getting an infection transmitted by the fish is very low. The real danger is that some spas have been using cheap Chin Chin fish instead of the real garra rufa. The scientific name of these is Tilapia, and they are sometimes called Kiss Kiss Fish, but be warned, they're not content with a small peck on the lips. These fish were bred from Chengdu, China and sold to uninformed people as Doctor Fish. The difference is that they have teeth! When they grow beyond 6 centimetres, these teeth can be big and sharp enough to actually pierce the skin and cause bleeding! Look at the fish before jumping in or dipping your toes.

My personal experience

I purchased 10 baby garra rufa fish in South London some years ago for £100, and set them up in a 80 litre tank, complete with nice rock formations that they could rest on, a filtering system and little plants that their babies could hide in. Soon they started breeding, and now I have around 20, which is enough to treat the problem areas around my elbows and hands. I found that spending just one hour with my hand dangling in there was sufficient in making my skin look smooth and pinkish for the next day - the only problem was finding an hour every day! I would sit there, watching them as they swam up to peeling dead skin, which looks remarkably like fish food, and pluck at it, twisting their bodies in an attempt to rip it off! The treatment was successful in relieving me of the main symptoms, but I did not experience complete remission, which I attribute to stress and the English climate.

Results of the Doctor Fish therapy after 3 weeksIs there supporting research or scientific evidence that fish therapy or Ichthyotherapy works?

Whilst this fish treatment has not been completely verified, a reputable study can be found in Volume 3 of the Oxford Journal, Evidence Based Complementary and Alternative Medicince, which can be read online here. The conclusions of the study were that fish therapy with garra rufa "could provide a viable treatment option for patients with psoriasis vulgaris". The photograph on the right was taken in the study to demonstrate the results of Doctor Fish therapy on three different patients after 3 weeks. The study also noted that the success of the Doctor Fish in treating psoriasis could be down to a combination of the following factors:

  • The Kangal spa is situated at a high altitude level of 1650-metres. This means that there is a lot of natural ultraviolet radiation from the sunlight, which acts as phototherapy and is proven to help with psoriasis.
  • The hotsprings have a special chemical composition, with high levels of selenium. Selenium deficiency has been linked to psoriasis, so this could be helpful.
  • The removal of skin scales and lesions by the fish helps the penetration of UV rays to the dermis.
  • The daily fish bath and micromassage associated with the fish can help to reduce stress and increase emotional well-being.

Since the treatment is still relatively unknown, it is best to talk to a certified dermatologist before making a decision. The fact that it is food deprivation which forces the fish to look for alternative food sources in dead skin also puts people off. However, for some, these hungry fish are nothing short of a miracle!