Fish Therapy Drug Interactions, Uses, Effectiveness, Safety & More
What is this page for?
First and foremost: how Fish Therapy interacts with medications. The heart of this page is the interaction list — every drug Fish Therapy is known to interact with, and how serious each one is.
But these pages have grown well beyond that into a full monograph — what Fish Therapy is, what people use it for and how strong the evidence is, its safety and side effects, and answers to the questions we’re asked most — written and reviewed by the clinical staff at HelloPharmacist. It’s educational information from our licensed clinical databases, not medical advice, and we don’t sell or endorse products. Our editorial policy
Check Fish Therapy against your medication
Add one medicationDrugs that interact with Fish Therapy
0 medications have a known interaction with Fish Therapy, graded by severity. Select any drug for the full evidence-based detail.
We don’t currently list any known drug interactions for Fish Therapy. This doesn’t guarantee none exist — always confirm with your pharmacist before combining supplements with your medications.
What Severity, Likelihood & Evidence Mean
Severity — How Serious It Can Be
- Major. Clinically significant; generally best avoided, or used only under direct professional supervision.
- Moderate. May need monitoring, a dose adjustment, or separating the times you take each one.
- Minor. Generally not clinically significant, but still worth noting and mentioning to your pharmacist.
- No known interaction. Checked against our sources with nothing documented — not the same as proven safety.
Likelihood — How Well It’s Documented
- Likely. Well-controlled human studies have demonstrated the likely existence of this interaction
- Probable. Interaction has not been documented in well-controlled studies, however, the interaction has been demonstrated in some small human studies or in controlled animal studies in conjunction with multiple case reports.
- Possible. Interaction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists
- Unlikely. Interaction has been demonstrated in animal or in lab research but has been shown not to occur in humans.
Where This Data Comes From
- Interaction records are evidence-graded and sourced from the Natural Medicines database (TRC Healthcare), the same reference used by pharmacists and hospitals.
- Each drug listed above links to the full report for that exact Fish Therapy combination — clinical detail, likelihood, evidence level, and citations.
- Content is reviewed by licensed HelloPharmacist pharmacists — see our data sources and editorial standards.
Fish Therapy: Uses, Safety & Side Effects
Fish therapy (also called ichthyotherapy or a 'fish pedicure') uses small Garra rufa fish to nibble away dead skin, and it is mostly used cosmetically or for skin conditions like psoriasis. Evidence that it treats any medical condition is very limited, and there are real infection and hygiene concerns. If you have a skin condition, talk with a dermatologist before trying it.
- Part used
- Live fish (commonly Garra rufa); the whole animal used in skin-immersion baths
- Common forms
- Spa fish baths (foot or full-body immersion with Garra rufa fish)
- Psoriasis
- Skin exfoliation and smoothing
- Eczema and dry skin
- Cosmetic foot care (pedicure)
- General relaxation
Popular and traditional uses — not proof it works. See “Uses & effectiveness” below for the evidence.
Hygiene and infection risks make this a cautious choice, especially with shared water.
Insufficient reliable information available; avoid using.
Read the full pregnancy detailInsufficient reliable information available; avoid using.
Read the full breastfeeding detailPregnancy & breastfeeding ratings are from Natural Medicines (Therapeutic Research Center). Safety guidance is general; always confirm with your pharmacist or doctor for your situation.
Overview
Fish therapy (sometimes called ichthyotherapy or a 'fish pedicure') is a practice where you place your feet or body into a tank of warm water filled with small fish. The fish most often used are Garra rufa, a freshwater species sometimes nicknamed 'doctor fish.' These fish gently nibble away dead and flaky skin.
The practice started in spas in parts of the Middle East and later became popular in spas across Europe and Asia, often marketed as a beauty treatment or a natural way to help skin conditions. People use it for both cosmetic skin smoothing and, in some places, as a complementary approach for psoriasis.
How it works
The proposed effect is simple and physical: Garra rufa fish lack certain teeth and instead nibble and suction at the skin, removing loose, dead surface cells. This acts like a gentle, natural form of exfoliation.
Some claims suggest the fish's saliva contains an enzyme that helps skin, but this is not well proven and is based mostly on theory or laboratory ideas. There is no strong evidence that the fish deliver any healing substance into the skin.
Does Fish Therapy work?
How to read these evidence grades
Natural Medicines’ 7-point scale. We show each rating’s label word-for-word.
For Fish Therapy, current evidence isn’t strong enough to rate any specific use. The conditions it has been studied for are listed below.
Also studied for 1 condition — evidence insufficient to rate
Insufficient Reliable Evidence To Rate Psoriasis
One small, retrospective study in adults with psoriasis shows that undergoing whole body fish therapy for 2 hours each day for 3 weeks improves the Psoriasis Area Severity Index (PASI) score by 72% when compared with baseline. Patients also reported subjective satisfaction with the treatment. The validity of these findings is limited by the use of retrospective chart review and the lack of a comparator group.
Source & disclaimer. Effectiveness ratings and evidence summaries are provided by Natural Medicines (Therapeutic Research Center) and shown as licensed. Where Natural Medicines hasn’t rated a use, HelloPharmacist’s pharmacists may add their own reviewed rating and evidence (each such entry is labeled). This is educational information, not medical advice — talk with your pharmacist or doctor before starting, stopping, or changing a supplement.
Safety & precautions
The biggest concern with fish therapy is infection and hygiene. Because the fish and water are often shared between many people and the fish cannot be sterilized, bacteria can spread. There have been reports of skin and nail infections linked to fish spas, and several places have banned or restricted the practice for this reason.
You should avoid fish therapy if you have diabetes, poor circulation, a weakened immune system, open cuts, sores, or any broken skin, since these raise the risk of serious infection. People with bleeding disorders should also avoid it.
Pregnancy and breastfeeding: There is no safety data for fish therapy during pregnancy or breastfeeding. Because of the infection risk, it is best to avoid it during these times unless your doctor says otherwise.
Side effects
Possible problems include skin or nail infections, irritation, small bleeding spots where the skin is broken, and the spread of fungal or bacterial organisms through shared water. Some people find the sensation uncomfortable or ticklish.
Rarely, infections can become serious, especially in people with diabetes or weakened immune systems. Stop and see a doctor if you notice redness, swelling, pain, pus, or a wound that is not healing after fish therapy.
Fish Therapy: Reported Adverse Effects
Documented safety reports on Fish Therapy from the evidence-graded Natural Medicines (TRC Healthcare) database, shown word-for-word from the licensed record.
Reports by conditionCritical illness (trauma) Dermatologic
In one case report, a young woman experienced toenail onychomadesis, or a reduction in nail plate production. She had received a fish therapy pedicure a few months prior to the start of these nail abnormalities. The authors hypothesize that the onychomadesis was caused by the direct trauma of the fish biting multiple nail units. However, this could not be confirmed.
Dermatitis Other
Multiple case reports suggest that fish therapy can increase the risk for bacterial infection. Studies of fish therapy water have identified multiple bacteria capable of causing disease. It is currently not possible to adequately sterilize the water without killing the fish. Additionally, when performed in a spa or salon setting, pedicure tubs cannot be adequately cleaned when fish are present. There is also a concern that the fish themselves can transmit pathogens between patients exposed to the same fish. Due to the high cost of the fish, spas and salons are more likely to re-use fish between clients. The risk for infection may be reduced when fish therapy is administered in a medical setting that maintains stringent sanitation practices.
In one case, a 64-year-old man developed superficial necrotic bullous dermatitis, found to be due to Aeromonas sobria, after undergoing a fish therapy pedicure. The patient had previously undiagnosed diabetes, likely increasing his risk for infection by this opportunistic pathogen. Also, a 21-year-old male developed a mycobacteriosis infection of his left foot that developed after receiving a fish therapy pedicure in Thailand. In another report, a 47-year-old male developed painful swelling of his right foot found to be due to infection with methicillin-resistant Staphylococcus aureus (MRSA). He had received a fish therapy pedicure 6 days prior to presenting to the emergency department. A 39-year-old woman developed bilateral dermatitis of the feet caused by Staphylococcus aureus. She had undergone a fish therapy pedicure 3 days prior to the development of dermatitis. Hand infections have also been reported, including a hardened, erythematous periungual plaque on the thumb of a 41-year-old male which developed 4 weeks after a fish manicure. Mycobacterium marinum was isolated from the lesion which resolved with 4 months of treatment with doxycycline 200mg daily orally.
Some experts caution about the potential for infection with bloodborne pathogens, such as HIV and hepatitis. However, there have been no reported cases of bloodborne pathogen transmission during fish therapy.
- Vanhooteghem O, Anseeuw D, Michel C, et al. Fish Pedicure-induced Aeromonas sobria Superficial Necrotic Bullous Dermatitis in a Previously Undiagnosed Diabetes Patient. What are the Risks of Fish Pedicure for Public Health? BJMMR. 2015;10(12):1-10.
- Veraldi S, Nazzaro G, Çuka E. Staphylococcus aureus infection of the feet following fish pedicure. Infection. 2014 Oct;42(5):925-6.
- Sugimoto K, Frei R, Graber P. Methicillin-resistant Staphylococcus aureus foot infection after fish pedicure. Infection. 2013 Oct;41(5):1013-5.
- Vanhooteghem O, Theate I. Fish pedicure-induced foot mycobacteriosis infection due to Mycobacterium marinum: a first case report. Eur J Dermatol. 2017 Jun 1;27(3):299-300.
- Lipner SR. Onychomadesis Following a Fish Pedicure. JAMA Dermatol. 2018 Sep 1;154(9):1091-1092.
- US Centers for Disease Control (CDC). Fish Pedicures and Fish Spas. August 2, 2016. Available at: https://www.cdc.gov/healthywater/hygiene/body/fish_pedicures.html. Accessed on June 15, 2020.
- Vanhooteghem O, Theate I, De Schaetzen V. Periungual Mycobacterium marinum Infection following a Fish Manicure. Skin Appendage Disord. 2021 Aug;7(5):393-396.
Adverse-effects data: Natural Medicines, Therapeutic Research Center
Dosing
There is no standard 'dose' for fish therapy, since it is a spa procedure rather than a supplement you take. Sessions are usually a set number of minutes in a spa setting.
If you choose to try it, only use a reputable, licensed facility that follows strict hygiene rules, and never share water with someone who has a skin infection. Talk with a pharmacist or doctor first, especially if you have any skin condition or health problem.
Fish Therapy & Pregnancy
Fish Therapy & Breastfeeding
© 2026 Therapeutic Research Center
Pregnancy & lactation ratings: Natural Medicines, Therapeutic Research Center
References & further reading
The 8 references that drive our Fish Therapy monograph and interaction data, from the evidence-graded Natural Medicines (TRC Healthcare) database. Citations with a link open the study on PubMed or the publisher’s site.
- Grassberger M, Hoch W. Ichthyotherapy as alternative treatment for patients with psoriasis: a pilot study. Evid Based Complement Alternat Med. 2006 Dec;3(4):483-8. PubMed
- Lipner SR. Onychomadesis Following a Fish Pedicure. JAMA Dermatol. 2018 Sep 1;154(9):1091-1092. PubMed
- Vanhooteghem O, Anseeuw D, Michel C, et al. Fish Pedicure-induced Aeromonas sobria Superficial Necrotic Bullous Dermatitis in a Previously Undiagnosed Diabetes Patient. What are the Risks of Fish Pedicure for Public Health? BJMMR. 2015;10(12):1-10. DOI
- Veraldi S, Nazzaro G, Çuka E. Staphylococcus aureus infection of the feet following fish pedicure. Infection. 2014 Oct;42(5):925-6. PubMed
- Sugimoto K, Frei R, Graber P. Methicillin-resistant Staphylococcus aureus foot infection after fish pedicure. Infection. 2013 Oct;41(5):1013-5. PubMed
- Vanhooteghem O, Theate I. Fish pedicure-induced foot mycobacteriosis infection due to Mycobacterium marinum: a first case report. Eur J Dermatol. 2017 Jun 1;27(3):299-300. PubMed
- US Centers for Disease Control (CDC). Fish Pedicures and Fish Spas. August 2, 2016. Available at: https://www.cdc.gov/healthywater/hygiene/body/fish_pedicures.html. Accessed on June 15, 2020.
- Vanhooteghem O, Theate I, De Schaetzen V. Periungual Mycobacterium marinum Infection following a Fish Manicure. Skin Appendage Disord. 2021 Aug;7(5):393-396.
This information is for education only and is not a substitute for professional medical advice. Always check with your pharmacist or doctor before starting, stopping, or combining supplements and medications.
Parts of this content are provided by the Therapeutic Research Center, LLC.
DISCLAIMER: Currently this does not check for drug-drug interactions. This is not an all-inclusive comprehensive list of potential interactions and is for informational purposes only. Not all interactions are known or well-reported in the scientific literature, and new interactions are continually being reported. Input is needed from a qualified healthcare provider including a pharmacist before starting any therapy. Application of clinical judgment is necessary.
© 2021 Therapeutic Research Center, LLC
Fish Therapy: Common Questions
What is Fish Therapy used for, and does it work?
Does Fish Therapy interact with prescription medications?
How are Fish Therapy interactions rated?
Is it safe to take Fish Therapy with my medications?
Where does this Fish Therapy interaction information come from?
What is Fish Therapy used for?
Is Fish Therapy safe?
Can Fish Therapy cure psoriasis?
Is it okay during pregnancy or breastfeeding?
Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy
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