Saturday, November 29, 2008
Icthyotherapy (fish pedicure)
Reported throughout the press and World Wide Web is the latest beauty fad from Japan - a fish pedicure. This involves dipping the feet into a special bath which contains up to 200 tiny toothless fish which then proceed to nibble away old skin cells leaving the new skin refreshed and invigorated. Well at least that is what the marketing hype tells us - but could this be true? To answer the question we first need to know a little bit about our skin which is made up of tiny cells, skin can be divided into two major layers. The Dermis which contains all the blood vessels, nerves and fat lies below than the skin we see which is an avascular (bloodless) layer called the Epidermis (epi means outside). The epidermis is very thin but made up of five distinct levels. As the lower cells pass upwards to the surface they become more compressed until they are cell-less flakes of keratin (protein). In order for the older keratin flakes to separate, squames (individual flakes) need a high water content which is the function of moisturising creams i.e. to add this water to the cells. In the normal course of events old squames leave the skin to be replaced by new ones so in effect like other animals we shed our skin every 28 days. 90% of household dust under the microscope is human epidermis. When the epidermis is damaged it may start to over produce keratin and this is seen either as callus or corns. Callus is a general distribution of hard skin (usually painless) whereas corns are more concentrated and can be painful. Biochemical factors in the blood determine the growth rate of the epidermal cells (which vary with individuals) and so damaged cells reproduce like normal cells but at a faster rate. This explains why callus and corns comes back again and the only way to deal with the concentrated mass of keratin (hyperkeratosis) is to physically scrape it away. Something we have known this since the time of the Ancient Greeks when the original surgical scalpel was first invented to remove hard skin. The key to any successful treatment is the safe removal of the keratin flakes and fish that nibble away skin cells whilst novel can be a valid way to control mild hyperkeratosis. Its usefulness is usually restricted to callus care and hence epi-dermabrasion by fish appears more in the range of beauty therapy than medical treatment but nibbling fish have been successfully used in the care of psoriatic skins (affects about 2-3% of the World Population). As far as I could trace the use of freshwater carp in the treatment of skin diseases (ichthyotherapy) originated in Turkey. The two species of fish used are Garra rufa and Cyprinion macrostomus, colloquially known as doctor fish and belong to the carp and minnow family. The fish have no teeth so cannot nibble (more imprtantly break into the dermis) but have a strong suck instread. Attracted to the many nutrients within the skin cells including those produced in healing wounds they swarm the skin plaque and proceed to lick it once it has been softened by the water. The constant ‘sucking’ by the younger fish has a gentle massaging effect on the recipient giving them a gently tingling sensation . Once the old cells are removed this gives the clinician better access to underlying lesions which then may be treated in a conventional way. So far anyway the introduction of fish pedicure to mainstream beauty therapy has caused no major alarm to authorities mainly due to the inability of the fish to damage healthy skin and to the best of my knowledge there have been no cases of cross infectionreported. Garra rufa can be kept in an aquarium at home but aquarium specimens are not particulalry easy to keep and ill suited for skin-feeding.