It has long been a common practice in Turkey, Asia and the Middle East to immerse all or part of the body in water containing fish (generally the species Garra rufa) for the removal of dead skin particles. In several countries, including France, an increasing number of establishments now offer this type of treatment – especially the type known as a fish pedicure – claiming aesthetic or wellness benefits, and also in some cases therapeutic effects.
Against this background, ANSES received a formal request from the Ministry of Health to assess the risks related to this type of practice, of immersing the feet in a tank containing Garra rufa, for aesthetic purposes.
To carry out this work, the Agency set up a dedicated working group of experts with complementary skills including scientists specialising in risks related to water, microbiology, fish health and dermatology, and involving two of its Expert Committees.
Overview of the health risks
Since 2010, fish pedicures have become increasingly available in Europe, in beauty or “wellness” salons where they are offered alongside other treatments. Although it is not possible to determine the extent of this practice in France with any precision, it would seem that several hundred establishments offer fish pedicures, with only a few dozen of these satisfying the applicable legal requirements (in particular the regulatory provisions on the protection of wild animals in captivity) entitling them to operate.
The work by ANSES revealed that there is currently no specific legal framework covering the health aspects of the practice of fish pedicures. There is little information available about the quality of the water in tanks in establishments practicing fish pedicures and there are have so far been no studies specifically investigating the presence and survival of pathogenic micro-organisms in populations of Garra rufa sold in France.
However, because of the presence of fish in the pedicure tanks, it is not possible to keep the water adequately disinfected, which makes it much harder to control the microbial risk. Furthermore, several cases of bacterial infection linked to fish-keeping and fish pedicures have already been described.
The Agency found that some customers are more susceptible than others to infection: diabetics, the immune-compromised (sick or undergoing treatment), or customers with dermal lesions on the feet).
Lastly, people with particularly thick skin (hyperkeratosis), sometimes caused by mycoses, may be especially drawn to fish pedicures, thus increasing the risk of contaminated water while also being themselves more susceptible to infection.
The Agency’s conclusions and recommendations
On the basis of these different elements, the Agency considers that there is a potential risk of transmission of pathogens (of human or animal origin via the water or the fish), during fish pedicures. The risk is probably low, except for especially susceptible user groups, but in the absence of data on this practice, the Agency recommends that data be collected on water quality and how it changes in establishments offering this type of pedicure, to enable the health risk to be quantified.
Furthermore, ANSES deems it necessary to regulate fish pedicure practices with suitable provisions, in order to ensure:
- user admission procedures and user and establishment hygiene, under the responsibility of qualified personnel;
- both inspection and self-monitoring of the facilities and their operation, in terms of water quality in the tanks and the general hygiene of the establishment;
- mandatory traceability of batches and health inspections of the fish;
- objective public information about the potential risks of this practice;
- information for personnel, including temporary staff, trainees and the staff of outside companies working within the establishment, on the risks of infection, especially by multi-drug-resistant strains of bacteria;
- the need to comply with workplace hygiene rules, and training for the personnel of these establishments to ensure their safety and that of users.