Unveiling the Dangers of Fish Pedicures With Phoenix Foot Specialist, Dr. Shylaja Arya: A Must Read!

Ever wonder about fish spas? The idea is novel and seems enjoyable enough– you soak your feet and little fish remove the calluses and dead skin off your feet while you passively feel the tickling sensation at the airport or some relaxed Eastern spa experience. A little strange, but what could go wrong, right? 

I heard about this trend from patients and in some articles, but have never seen them in person until last week!

I was lucky enough to bring in the New Year in Mexico with kind & wonderful friends by my side. What a beautiful place, we had an absolute blast enjoying the weather and each other. Walking away from the beach and in through town, I spotted a “Fish Spa” Station touting the wonders of an “ichthyotherapy experience” under $15 USD! There was an American woman with neatly pulled back hair, donned with sunglasses, hat and visible white cast of sunscreen, likely in her 60’s, sitting and enjoying herself when I got there and I waved to her and smiled as I watched the little fish circle around her feet. She mentioned the sensation was just “ticklish” and I let her enjoy herself quietly. I walked around the set up and inspected the units, the fish, and the sign advertising the treatments. I spoke with the attendant at the stations and got some small pieces of information that I’ll include in the blog below based on what he told me. Please note I did not participate, as my first thought was–how do they clean the tank without getting rid of the fish?! I did some research after returning home, so I could share my honest opinion. Here’s the short of it: I don’t think the practice is safe or ethical, and after further research and a discussion with an Infectious Disease colleague–this is a dangerous practice overall, with countless documented studies of different fungal/bacterial infections behind it, and should be avoided. 

There are some incidents in medical care where we do use creatures, like fish or maggots, but almost exclusively in a controlled and sterile environment and very very rarely. Never in a casual setting. Long story short, I recommend not doing Fish Pedicures. There are plenty of great ways to exfoliate the dead skin cells on our faces. We use lotions, loofah, acids, and all kinds of potions on our faces… why not use products versus fish…would you let fish chew dead skin cells off your face? At my practice I carry medical grade creams that buff off the dead layers in a safe way, without using sharp tools or putting patients who have at risk feet, at risk. And if you’ve used these spas before and you’ve been healthy and fine since, that’s very good. I’m not here to argue with you or convince you. Your decisions are yours. I am only cautioning based on my expertise. 

What kind of fish are in fish spas?

The fish we are talking about are a carp like fish called Garra rufa (or “doctor fish”). Garra rufa are native to the Middle East. You can see them if you look carefully in my picture from Mexico. As it turns out, these fish do not eat human skin naturally. They prefer vegetation from the bottom of the sea, usually plankton & other plant sources. Unfortunately, they are starved before going into the tanks so the dead skin cells are what they eat out of forced starvation. These fish can’t possibly be disposed of after each person, so their feces and the prior individual’s foot scales are circulating in the same water throughout the day.

4 Reasons You Should Avoid A Fish Pedicure

1. Infection! As mentioned above, there is no way to disinfect the tubs or the fish. It would be very expensive to dispose of the fish (not to mention inhumane) with each customer. By reusing the fish hearty fungal and bacterial infections that are challenges to treat, like Streptococcus Agalactaie Group B and Mycobacterium Marinum, have been associated with these Garra rufa fish strains and this type of pedicure. Remember, these are superbugs and therefore can be more difficult to treat compared to a traditional bacterial infection!
2. Unpredictable Risks! Soaking for any length of time in warm water with even a small cut in a sterile pedicure environment can predispose a patient to infections, so adding in the fish themselves creates unpredictability and concern. In many peer-reviewed articles they do discuss trauma to the nail and skin around the cuticle is not uncommon with Garra rufa, which makes total sense, because they lack discretion and are just nibbling any areas out of hunger. They don’t know that your sealant for infection is the cuticle, so if there’s a piece hanging–they go for it.  Furthermore, you may not even be sharing the tub with Garra rufa but rather another cheaper, more aggressive fish variety called Chin-Chin! These Chinese fish look similar but they grow teeth. As a result, they can bite and draw blood. This further raises the risk of infection! 
3. Inhumane! The fish are starved of their natural food and habitat, left with only the choice to eat the dead skin cells. Certainly, since we know this now, it’s important to “do better” and not promote this type of inappropriate food source for the fish. 
4. Environmental Responsibility! According to the U.S. Fish and Wildlife Service, when fish like Garra rufa (who are not native to the United States) are released into the wild, it can ruin our natural ecosystem. In fact, it is such a novelty overseas because it has been banned in many states in the United States and Europe as a practice.

Please note if you have any high risk foot issues including diabetes, vascular, compromise (blood flow issues), history of ingrown toenails, any small cuts, you’ve recently shaved your legs or feet, history of amputation… the fish spa practice is certainly not for you. A pedicure may not even be for you. If you love getting pedicures, please check out  my blog on 10 tips for a safe pedicure!

Thank you for reading our article! We hope you enjoyed learning more about this unpredictable practice. As always, should you have any questions don’t hesitate to reach out to the office. We are conveniently located in the heart of Arcadia, Phoenix with surrounding care to Scottsdale, Biltmore, and the Greater Phoenix area. We are open Friday afternoons, Saturdays, and at lunch time. We try to be available for you and hope to take care of you soon!

Some peer-reviewed articles to check out, that I used collecting my information: 

• Vanhooteghem O, Theate I. Fish pedicure-induced foot mycobacteriosis infection due to Mycobacterium marinum: a first case report. Eur J Dermatol. 2017 Jun 1;27(3):299-300. doi: 10.1684/ejd.2017.2976. PMID: 28677579.
• Verner-Jeffreys DW, Baker-Austin C, Pond MJ, Rimmer GS, Kerr R, Stone D, Griffin R, White P, Stinton N, Denham K, Leigh J, Jones N, Longshaw M, Feist SW. Zoonotic disease pathogens in fish used for pedicure. Emerg Infect Dis. 2012 Jun;18(6):1006-8. doi: 10.3201/eid1806.111782. PMID: 22608013; PMCID: PMC3358165.
• https://jamanetwork.com/journals/jamadermatology/article-abstract/2686152

Author

Dr. Shylaja Arya Dr. Arya is the owner of Arya Foot & Ankle, a podiatry practice that serves the greater Phoenix area with same day, Saturday, and lunch time appointments. She is a level 500 yoga instructor, tennis player, dog mom and shoe lover!