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ichthyotherapyIchthyotherapy is defined as the treatment of skin disease such as psoriasis and ichthyosis with the so-called “doctor fish of Kangal”.

In the hot pools of Kangal, in Turkey where food plankton is reportedly scarce, two fish speciesfrom the carp and minnow family Cyprinion macrostomus and Garra rufafeed on the skin scales of patients with illnessessuch as psoriasis and atopic dermatitis.

Treatment efficacy has been evaluated in only two published studies. The first clinical study, by Özcelik et al. (2000), involved 87 patients from the Kangal Hot Spring Spa. The researchers demonstrated significant improvement in psoriasis symptoms and PASI score (Psoriasis Area and Severity Index) within just 3 days p<0.01). Follow-up at 21 days was available only for 14 patients, but was associated with complete and lasting benefits in 8 (57%) of them. The remaining six patients had improvement in their symptoms, but not complete resolution.

The second study, by Grassberger and Hoch (2006), was a retrospective analysis of 67 psoriasis patients who underwent 3 weeks of ichthyotherapy in an outpatient treatment facility in Austria.

The primary efficacy outcome measure was the overall total reduction in PASI score and the proportion of patients with 50% and 75% improvement in PASI score. PASI scores were assessed using high-resolution digital color photographs taken at baseline and at the end of the 3-week treatment period. Baseline measurements were those made just prior to the beginning of treatment. Additionally, response to treatment was defined according to the rate of improvement in PASI score. Patientreported outcomes were evaluated by a short questionnaire administered immediatelyafter the 3-week course of treatment, and by a follow-up questionnaire sent toall patients 3–36 months after the study treatment..

At the end of the 3-week treatment course, 31 of the 67 patients (46 %) achievedPASI-75 and an additional 30 patients (45 %) achieved PASI-50. For all patients, theaverage reduction in PASI score compared to baseline was 71.7 % (P <0.0001). All of the patients experienced clinical improvement: completeresolution in three patients (4.5 %), marked improvement in 29 (43.3 %), moderateimprovement in 29 (43.3 %) and slight improvement in 6 (8.9 %).Assessment of patient-reported outcomes demonstrated substantial satisfactionwith the treatment.


Grassberger M, Hoch W. 2006.Ichthyotherapy as alternative treatment for patients with psoriasis: a pilot study. Evid Based Complement Alternat Med 3(4):483–488.  pdf

Özcelik S, Polat HH, AkyolM, Yalcin AN, Ozcelik D, Marufihah M. 2000.Kangal hot spring with fish and psoriasis treatment. J Dermatol 27(6):386–390.

Özçelik S, Berksoy S. 2015. Balneotherapy in Kangal hot spring with fish.Cumhuriyet Med J. 37: 170-175.  pdf

Grassberger M, Sherman RA. 2013. Ichthyotherapy. In: Grassberger, M., R.A. Sherman, O. Gileva, C.M.H. Kim & K. Y. Mumcuoglu (Eds). Biotherapy – History, Principles and Practice: A Practical Guide to the Diagnosis and Treatment of Disease using Living Organisms. Springer Pub., Heidelberg, pp. 147-176.

Books on Biotherapy (in chronological order):

A Complete Guide to Maggot Therapy. Clinical Practice, Therapeutic Principles, Production, Distribution, and Ethics. 2022. Frank Stadler (editor). OpenBook Publishers. link >> Clinical Hirudotherapy: Practical Guide: Book 1. General Hirudotherapy. Moscow, 2018...

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