BANGKOK, Thailand -- A pool of flesh-eating fish may conjure up painful visions of pointy-toothed piranhas, but that doesn't stop countless people offering themselves to gentler fish which hungrily suck dead skin, prompting new health warnings about infections from mixing blood and water.

"It is the same feeling like a mosquito biting you," said Lomporn Chintee, 27, after letting herself be nibbled in a "fish spa" on Phi Phi island.

"It tickles. I didn't know there was any health risk. But I'm not afraid. I would do it again," Lomporn said.

Clive Helman, visiting Bangkok from England, said he was intrigued by the idea.

"I would consider having it done if the place was pretty clean looking. There is a place on Phi Phi where you could give the fish your full body, with no clothes on. I would start with my feet, though, and perhaps then give the full body treatment a go, despite the alleged dangers."

The process is akin to sticking your limbs, torso or head into a big aquarium which is filled with lots of small fish, and allowing them to tenderly assault your skin in an uninhibited feeding frenzy.

The toothless fish do not bite into living flesh, and instead suck and devour loose bits of dead or unhealthy skin, resulting in an aquatic exfoliation.

The fish are said to like licking dead skin because it is relatively easy for them to remove, especially after becoming soft in the water.

Devotees delight in the "smoothness" of their skin after spending 15 minutes or longer, relaxing in a relatively still position, though the fish aren't scared away if a person jerks from being tickled too much.

Some victims stricken with gout, psoriasis, eczema, bunions and other health problems have insisted the fish cured them, resulting in widespread debate and first-person testimonies on Internet about the treatment's benefits and dangers.

Most establishments throughout the world use toothless Garra Rufa fish, also known as "doctor fish," though some places describe their fish as toothless carp or Cyprinion Macrostomus.

Health officials in some U.S. states, however, have closed down fish spas after warning that customers with tiny cuts or wounds have soaked themselves in the fish tanks alongside other customers who have similar hard-to-see lesions, thus creating the possibility of receiving or transmitting infectious diseases.

Infected human blood can turn a fresh water aquarium into a potential mixing vessel, even with the fish.

Bits of uneaten, dead or diseased skin floating in the tank during the treatment add to the risk of additional skin diseases, according to health officials.

Britain's Health Protection Agency recently announced it was investigating the possibility of human infection from "fish spa pedicures," but had no confirmed cases of disease.

On a Yorkshire-based Gout Support Forum (, one man claimed his hobbling gout was cured by the fish which purportedly sucked out the protein from painful uric crystals in his big toe -- but no one was able to confirm the fish's role.

In 2011, Thailand's Public Health Ministry advised people who have injuries on their skin not to use the spas.

But there have been no reports of any diseases transmitted by the estimated 4,000 fish spas which opened throughout the country in recent years.

"I have had this fish tank business for one year, and use black honey fish, and keep everything very clean," said Pam, who owns Charlie's Massage and Beauty on Bangkok's tourist-packed Khao San Road.

"I can use other fish, but I like these because they are strong and easy to take care of. They eat only a little fish food. If I feed them too much, they become lazy and don't eat the peoples' skin.

"I have thousands of fish in these three tanks," she said, gesturing toward rectangular, bathtub-sized, glass-walled aquariums where a cluster of foreigners were sitting on wood benches, dangling their bare legs in the lukewarm water.

"You can see the tanks have a UV light to kill any worms or anything else. I change the water every day. If I do not change the water, it will smell bad and the fish die.

"We also check the person's feet before they go in. If we see a little bit of blood, then they cannot go down into the water. Before they put their feet down, we must wash their feet first," Pam said, pointing to a plastic bucket, a pile of white wash cloths, and a smiling female assistant.

A French woman, offering her bare feet and legs to a shoal of nuzzling fish at Charlies, said she did not know about the health warnings.

"I would like more information, because I care about this. But when we go in the swimming pool, it is the same as being in water with other people."

After being reminded that swimming pools use chlorine to kill germs -- which is impossible with the fish because otherwise they would perish -- the French woman watched the fish nibbling her and shrugged her shoulders.

"I don't care."

Elsewhere along Khao San Road, the slightly grottier Club Fish Gallery offers 15 minutes in its tank for 100 baht, which includes a cocktail such as "Fuck Around the World" which mixes gin, tequila, vodka, whiskey, lime juice and blue curacao liqueur, or "Sex in the Pool" which combines white rum, gin, pineapple juice and lemon, among other drinks on a menu.

nsitive people say bigger fish can create a slightly uncomfortable feeling if they have sharp mouths.

Tiny fish are preferable, but the sensation can be like nudges from needles.

Using fish for medical purposes apparently began in Turkey, where some spas claim they can "cure" acne, eczema and psoriasis after lengthy, repeat immersions lasting eight hours a day, for three weeks.

One legend tells of a Turkish shepherd who, 100 years ago, rested his wounded foot among some fish in a thermal spring, and soon discovered he was healed.

Word spread and such treatments became increasingly popular during the 1960s in Turkey.

Today, they are big business at deluxe resort spas scattered across the globe, in addition to the cheaper treatments available in Thailand and elsewhere in Southeast Asia.


Richard S. Ehrlich is a Bangkok-based journalist from San Francisco, California, reporting news from Asia since 1978, and recipient of Columbia University's Foreign Correspondent's Award. He is a co-author of three non-fiction books about Thailand, including "Hello My Big Big Honey!" Love Letters to Bangkok Bar Girls and Their Revealing Interviews; 60 Stories of Royal Lineage; and Chronicle of Thailand: Headline News Since 1946. Mr. Ehrlich also contributed to the final chapter, Ceremonies and Regalia, in a new book titled King Bhumibol Adulyadej, A Life's Work: Thailand's Monarchy in Perspective.

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(Copyright 2012 Richard S Ehrlich)