Immersion of all or part of the body in water containing fish (usually of the species Garra rufa (1)) removing scales from the skin, has been a practice that has existed for many years in Turkey, Asia and the Middle East. In many countries, including France, a growing number of establishments are offering this type of care – in particular a so-called “fish pedicure” offer – promoting aesthetic or well-being effects, but also sometimes therapeutic effects.
In this context, ANSES was asked by the Ministry of Health to carry out an assessment of the risks of disease transmission through fish or water. The work carried out by the Agency focused on the risks associated with the immersion of the feet, exclusively for aesthetic and/or well-being purposes.
Agency expertise
To carry out this work, the Agency relied on the collective expertise of a multidisciplinary working group bringing together scientists specializing in water-related risks, microbiology, fish health, dermatology and involving two of its specialized expert committees.
The points emerging from the work of the Agency are as follows:
- In France the practice of the “fish pedicure” is not governed by any specific health regulations;
- since 2010, the “fish pedicure” pedicure care offer is developing very significantly in Europe, particularly in France, in aesthetic or “well-being” establishments where it is set up, most often in addition to other services. It is not possible to determine precisely the extent of this practice in France. It seems like several hundred establishments offer a “fish pedicure” activity, only a few dozen of them satisfying the legal opening conditions(2) ;
- cases of bacterial infections linked to aquarium and pedicure practices have been described;
- data on water quality in establishments practicing “fish pedicure” are rare and there are no specific data on the presence and prevalence of pathogenic microorganisms in fish Garra rufa marketed in France;
- due to the presence of fish, it is impossible to maintain disinfectant water in the tanks used for the “fish pedicure” as this would kill them;
- some users (diabetics, immunosuppressed, users with skin lesions on their feet) constitute a susceptible population at higher risk of infection;
- the practice of “fish pedicure” can attract more particularly people with thickening of the skin (hyperkeratosis), likely to be of fungal originwhich thus increase, on the one hand, the risk of water contamination and which present, on the other hand, increased susceptibility to infections.
The Agency’s conclusions
Considering these different elements and although there are currently no documented cases of infection linked to the so-called “fish pedicure” care offer, the Agency considers that there is a potential risk of transmission of pathogens of human or animal origin through water or fish, during the practice of “fish pedicure”. This risk is probably low, except for sensitive user populations, however, due to the lack of data, it is not currently possible to quantify this risk. Consequently, the Agency recommends the acquisition of data in order to be able to characterize the health risk more precisely and identify cases of infections linked to frequenting establishments offering this type of pedicure treatment.
Besides, ANSES considers it necessary to regulate the practices of “fish pedicure” by appropriate regulations to ensure in particular:
- “fish pedicure” tubs containing water guaranteeing protection once morest the risk of infection for the user;
- procedures for admission and hygiene of users, hygiene of the establishment under the responsibility of qualified personnel;
- control and self-monitoring of the operation of the facilities, the quality of the water in the tanks and the general hygiene of the establishment;
- the obligation to trace batches and the health control of fish;
- objective information of the public on the dangers incurred during this practice;
- informing staff, including temporary workers, trainees and staff from external companies working within the establishment, regarding the risks of infection, in particular by bacteria that are multi-resistant to antibiotics, and the need to respect occupational hygiene rules;
- the training of the personnel of these establishments to guarantee their safety and that of the users.
Finally, the Agency also recalls the need to take into account the regulations relating to captive wildlife governing the conditions for opening establishments offering the practice of “fish pedicure”.
(1) more rarely Nile Tilapia (Oreochromis niloticus), sometimes used in Asian countries and for which the risks are greater because it has labial teeth that can traumatize the user’s integument. The Agency’s work relates only to Garra rufa.
(2) In accordance with regulatory provisions relating to captive wildlife.
