The fish that nibble dead skin off human feet are called Garra rufa, a small freshwater species native to Turkey and the Middle East. Commonly known as “doctor fish,” “nibble fish,” or “Kangal fish,” they belong to the carp family and grow to only a few inches long. These fish became famous for their unusual feeding habit: gently grazing on flaking, dead skin cells while leaving healthy skin underneath untouched.
Why Garra Rufa Eat Dead Skin
In their natural habitat, the hot thermal springs of Kangal, Turkey, Garra rufa feed on plankton and algae. But the high temperature of these springs makes plankton scarce, so dead human skin became an easily available food source. When people bathed in the pools, the fish adapted to nibbling on their skin as an alternative meal. This isn’t aggressive biting. Garra rufa don’t have the kind of teeth that could tear into living tissue. They use a gentle sucking and scraping motion to remove only the outermost layer of dead skin cells, producing a tingling sensation that most people describe as odd but painless.
The behavior is partly opportunistic. In spa settings, the fish are kept in warm water with limited food alternatives, which makes human skin more appealing to them. Some animal welfare advocates have raised concerns that fish in commercial spas may be underfed to encourage more aggressive nibbling, though this is difficult to verify across the industry.
Fish Pedicures and How They Work
A typical fish pedicure involves placing your feet (or sometimes hands) into a basin containing dozens of Garra rufa. The fish swarm around your skin and begin feeding on dead cells. Sessions at commercial spas generally last 15 to 30 minutes. The experience feels like light tickling or tiny pinches, and it leaves the skin feeling smoother afterward, similar to a mild exfoliation.
Clinical use of these fish goes much further. In Kangal, Turkey, psoriasis patients have historically bathed in thermal pools twice daily for sessions averaging over seven hours, staying for nearly 12 days on average. In clinical settings in Austria, patients with psoriasis took two-hour baths daily for three weeks, combined with brief ultraviolet light therapy afterward. The approach is sometimes called ichthyotherapy.
Results for Psoriasis Patients
The most rigorous data comes from a pilot study of 67 psoriasis patients treated with ichthyotherapy in Austria between 2002 and 2004. After three weeks of daily treatment, patients saw an average 71.7% reduction in their psoriasis severity scores. Nearly half the patients (46.3%) achieved a 75% or greater improvement, and 91% achieved at least a 50% improvement. Every single patient responded to some degree.
The benefits lasted well beyond treatment. The average remission period was about 8.5 months, and 65% of patients said that when their symptoms did return, the flare-up was less severe than before. When asked to compare the fish therapy to other treatments they had tried, 87.5% rated it more favorably. Side effects were minimal: one patient experienced mild bleeding from open crusted lesions, and two others had minor sunburn-like redness from the UV light component.
It’s worth noting that the UV light exposure likely contributed to these results, so it’s hard to separate what the fish alone accomplished from what the combination therapy achieved.
Health Risks of Fish Pedicures
Despite the appeal, fish pedicures carry real infection risks. A CDC-affiliated study found a surprisingly diverse range of bacteria in fish spa water and on the fish themselves, including several species capable of causing serious soft tissue infections. Among them were Aeromonas (a waterborne pathogen), Vibrio vulnificus (which can cause wound infections and life-threatening bloodstream infections, particularly in people with liver disease, diabetes, or weakened immune systems), strains of Vibrio cholerae, Mycobacteria species linked to skin infections, and Streptococcus agalactiae, a bacterium that can cause pneumonia, bone and joint infections, and bloodstream infections.
Individual case reports have documented additional problems. A 2017 case linked fish pedicures to mycobacterial skin infection. In another case, a woman in her 20s developed onychomadesis, a condition where the toenails detach and shed, after a fish pedicure. These aren’t common outcomes, but they illustrate that the procedure isn’t purely harmless.
The core sanitation problem is straightforward: you cannot sterilize a living fish. Standard pedicure regulations require all tools to be sterilized between clients, and that’s physically impossible here. If one customer has an open wound or a skin infection, the fish and the water they swim in become potential carriers for the next person who dips their feet in.
Where Fish Pedicures Are Banned
At least 14 U.S. states have banned fish pedicures, including Texas, Florida, Massachusetts, New Jersey, Pennsylvania, Maine, New Hampshire, and Washington. The bans exist because regulators concluded the procedure simply cannot meet existing sanitary standards for pedicure services. The fundamental questions remain unanswered by existing law: what happens to the water if a client bleeds into it, and whether the fish in that tank should be treated any differently afterward.
In states where the practice remains legal, regulation varies widely. Some require UV filtration systems in the water, but these have limited effectiveness against all the bacterial species identified in spa settings. The United Kingdom has allowed fish pedicures to continue with guidelines in place, though infections have still been reported there.
Other Fish That Feed on Skin
Garra rufa are the most well-known skin-eating fish, but they’re not the only species used commercially. Some spas have substituted a related species called Cyprinion macrostomus, or even unrelated fish like certain tilapia species, which are cheaper and grow faster. This substitution raises additional concerns. Tilapia have actual teeth with multiple pointed tips designed for shredding plant material. Unlike Garra rufa’s gentle scraping, tilapia can break the skin and cause small wounds, creating a direct entry point for the bacteria present in spa water.
If you’re considering a fish pedicure, verifying the species being used matters. Garra rufa are small (typically under 4 inches), dark brownish-gray, and produce a light tickling sensation. If the fish are larger or the nibbling feels sharp, they may not be true doctor fish.