Psoriasis symptoms on your feet can be bothersome, and treating thick scales, plaques, fissures, or extremely dry skin can be complicated. You may be tempted to scrub away your scales, but this often does more harm than good. Picking at scales may cause bleeding and increases your risk of infection. Fish pedicures have become a topic among members of MyPsoriasisTeam as they discuss ways to remove dead skin cells and manage their psoriasis.

“Can you remember a few years ago when there was a trend for fish pedicures? The idea was to dip your toes into a tank of little fish that nibbled the dead skin,” one member shared. Another responded, “I do recall the fish/foot thing! I was shocked back then, but maybe now it’s worth a try?”

With the growing popularity of fish pedicures in recent years, you may be interested in trying one to treat your psoriasis. In this article, we’ll break down what they are and whether they’re safe and effective for people with inflammatory skin conditions like psoriasis.

What Is a Fish Pedicure?

Ichthyotherapy — or a fish pedicure — is a type of pedicure that uses Garra rufa fish that eat dead skin cells and exfoliate the skin. They’re also known as “doctor fish” for their reported healing and skin-rejuvenating properties. This skin treatment originated at the Kangal Fish Spring in Turkey, where it was first used to treat a shepherd’s foot injuries in the early 1900s.

Since then, the Turkish Ministry of Health has designated the spring as a certified thermal health center. Kangal Fish Spring offers a three-week-long treatment for people with psoriasis on their feet to help clear their symptoms.

Fish pedicures have become increasingly popular in tourist destinations around the world and in the United States. According to one government report, spas and salons started offering fish pedicures in the U.S. and Europe between 2008 and 2009.

During a fish pedicure, you put your feet into a tub of water with the fish. They quickly begin nibbling on your feet and eating the dry, dead skin that contributes to psoriasis symptoms. Anecdotal reports from people who have tried fish pedicures say they can help soften calluses and increase circulation in the feet.

Are Fish Pedicures Effective for Treating Psoriasis?

A handful of small studies have looked into whether fish pedicures can help treat psoriasis. While these studies have reported some positive results, larger ones are needed to confirm the findings and determine whether fish pedicures are safe.

The Journal of Dermatology cites an older study of 87 people with psoriasis who were treated with fish pedicures for 21 days. They found that their Psoriasis Area and Severity Index (PASI) scores were significantly lower after treatment. This means that their psoriasis symptoms improved over time. The authors also reported that 35 of the study participants had longer-lasting results when compared to topical corticosteroid treatment.

Another study investigated using fish pedicures alongside ultraviolet A (UVA) light therapy for treating psoriasis on the feet. Overall, participants experienced a 71.7 percent reduction in the PASI scores. Many of the participants also reported that they had better outcomes after fish pedicures compared to other treatments and that they had less-severe relapses.

Safety and Ethical Concerns With Fish Pedicures

Although there was an initial boom in the popularity of fish pedicures, many health officials have safety concerns. The Centers for Disease Control and Prevention (CDC) reports that several states have banned fish pedicures because they can be unsanitary. They also noted that fish pedicures technically aren’t considered pedicures under the legal definition.

Unlike regular pedicures, which use tubs with disposable liners, the tubs used in fish pedicures can’t be cleaned properly between customers. Fish spa owners would have to change out the fish and water after every pedicure, which can quickly become expensive.

Additionally, the fish themselves can’t be cleaned or disinfected to prevent the spread of bacteria. Instead, it’s more likely that owners will use the same fish several times with different customers, putting the customers at risk of infection.

There’s also a chance that the fish spa owners use the wrong fish. Garra rufa can be mistaken for another type of fish known as Chinese chin chin, which can grow teeth and bite customers hard enough to draw blood. Open cuts allow pathogens (viruses or bacteria) to enter the body more easily, increasing the risk of infection.

Some experts have also reported ethical concerns with the Garra rufa fish. To force them to eat dead human skin, which is not their food of choice, many spas and salons starve their fish. There’s also a concern about getting them safely into the U.S. — they’re not a native species, so the fish are flown in from overseas. The fish may not survive the journey, which can be deemed unethical. If they’re released into the wild, they can become a threat to native plants and animals.

Risk of Infection and Complications After Fish Pedicures

Case studies have also reported a few individuals developing skin infections or toenail problems after having fish pedicures. Although these reports describe single cases, they show that there’s a risk of complications.

Here’s a summary of case reports involving complications from fish pedicures:

• One person became infected with Mycobacterium marinum, a bacteria similar to tuberculosis that infects fish and can be transferred to humans if they’re bitten.
• Another person developed a Staphylococcus aureus infection on their feet that caused the formation of crusts and scales, along with skin itching, burning, and a pus-like discharge.
• An individual developed onychomadesis (separation of the nail from the nail bed).

Note that nail problems are common in people with psoriasis — fish pedicures may put you at an additional risk of uncomfortable nail symptoms or make them worse. It’s also worth noting that people with impaired immune systems or other underlying health conditions, such as diabetes or cardiovascular disease, may have a harder time healing foot wounds or infections.

Getting a Fish Pedicure Safely

If you’re interested in trying a fish pedicure to treat psoriasis symptoms such as skin peeling from your toes, it’s important to first do some research. Check your state laws to make sure fish pedicures are legal where you live — if a spa or salon is offering fish pedicures in a state where they’re illegal, it’s best not to go. States that have banned fish pedicures include:

• California
• Maine
• Massachusetts
• New Jersey
• New York
• Texas
• Washington

Many tourist destinations around the world also offer fish pedicures for those who may not be able to get them at home. Be sure to look up local laws of where you’re traveling to check whether fish spas and salons are regulated in the country you’re visiting. It’s important to note that fish pedicures are also banned in Mexico and some European countries.

Ask the staff at the nail spa when the last time the tub containing the fish was cleaned and whether the fish have been used before. Avoid getting a pedicure if you have any open cuts, deep cracks, or wounds on your feet. After your pedicure, clean your feet with warm water and soap to reduce your risk of infection.

Talk With Others Who Understand

MyPsoriasisTeam is the social network for people with psoriasis and their loved ones. On MyPsoriasisTeam, more than 117,000 members come together to ask questions, give advice, and share their stories with others who understand life with psoriasis.

Have you tried a fish pedicure to treat psoriasis on your feet? Share your experience with this condition in the comments below, or start a conversation by posting on your Activities page.