Fish Pedicures and Fish Spas

What is a fish pedicure?

A fish pedicure, also known as a fish spa, involves patrons dipping their feet in a tub of water filled with small fish called Garra rufa. Garra rufa are sometimes referred to as “doctor fish” because they eat away dead skin found on peoples’ feet, leaving newer skin exposed.

Garra rufa are native to the Middle East, where they have been used as a medical treatment for individuals with skin diseases, like psoriasis (1). One study has illustrated the effectiveness of fish pedicures in the treatment of psoriasis; however, this treatment was performed in a controlled setting at a medical university in Austria, not at a nail salon (2).

CDC is not aware of any published reports on illnesses resulting from fish pedicures. Nail salon foot baths, however, have caused outbreaks of nontuberculous mycobacterial infections that left infected pedicure customers with boils and scars (3).

Why have some states banned the use of fish pedicures?

Each state has the authority to ban fish pedicures. Currently, over 10 states have banned the use of fish pedicures.

Most of the bans are based on at least one of the following reasons:

• The fish pedicure tubs cannot be sufficiently cleaned between customers when the fish are present.
• The fish themselves cannot be disinfected or sanitized between customers. Due to the cost of the fish, salon owners are likely to use the same fish multiple times with different customers, which increases the risk of spreading infection.
• Chinese Chinchin, another species of fish that is often mislabeled as Garra rufa and used in fish pedicures, grows teeth and can draw blood, increasing the risk of infection.
• According to the U.S. Fish and Wildlife Service, Garra rufa could pose a threat to native plant and animal life if released into the wild because the fish is not native to the United States.
• Fish pedicures do not meet the legal definition of a pedicure.
• Regulations specifying that fish at a salon must be contained in an aquarium.
• The fish must be starved to eat skin, which might be considered animal cruelty.

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Resources

• Verner-Jeffreys DW, Baker-Austin C, Pond MJ, Rimmer GSE, Kerr R, Stone D, et al. Zoonotic disease pathogens in fish used for pedicure [letter]. Emerg Infect Dis. 2012;18(6).
• Health Protection Agency Fish Spa Working Group. Guidance on the management of the public health risks from fish pedicures: draft for consultation. London: Health Protection Agency; 2011.
• USEPA/ CDC. Preventing Pedicure Foot Spa Infections
• USEPA. Recommended Cleaning and Disinfection Procedures for Foot Spa Basins in Salons

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References

1. Undar L, Akpinar MA, Yanikoglu A. “Doctor fish” and psoriasis. Lancet 1990;335;470-1.
2. Grassberger M, Hoch W. Ichthyotherapy as alternative treatment for patients with psoriasis: a pilot study. Evid Based Complement Alternat Med. 2006;3(4):483-8.
3. Vugia DJ, Jang Y, Zizek C, Ely J, Winthrop KL, Desmond E. Mycobacteria in nail salon whirlpool footbaths, California. Emerg Infect Dis. 2005;11(4):616-8.

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