The popularity of fish spas has swelled in the past months, ever since the first spa opened its doors in Malta less than a year ago, but it is not the first time that its health risks have been questioned.

Last Tuesday the UK Health Protection Agency was reported in various UK media as having highlighted some of these risks, pointing out that it was concerned that this latest craze could contribute to the spread of infections.

The Superintendence of Public Health in Malta has been following research into the possibility of transmission of infections, and on 3 October informed the operators of these spas of a number of reccomended measures, a Health Ministry spokesperson told The Malta Independent.

In the meantime the Health Promotion Agency (UK) published further information related to their research, stating that although the risk of transmission of infection is considered to be very low, the experts feel that as a precaution vulnerable persons should avoid this type of therapy.

The agency is in fact preparing a report related to this research and its results, and when completed this will be sent to the operators to inform them of additional measures that should be put in place. The Superintendence aims to continue to follow other research in the field.

Fish spa therapy, sometimes known as ‘doctor fish spa therapy’, involves shoals of tiny flesh-eating fish, commonly known as Garra Rufa, which are used to clean and exfoliate the skin, by feeding on the dead skin.

The treatment involves customers placing their feet in tanks of warm freshwater containing dozens of these toothless Garra Rufa fish, which then suck and gently nibble away at dry and dead skin.

The fish do not touch the healthy skin, feeding only on the affected and dead areas, allowing the healthy skin to grow. Similar spas have begun to open up on the island, after their growing popularity worldwide.

The exfoliation of the Garra Rufa fish is said to stimulate blood flow and improve circulation, remove bacteria and reduce foot odour, as well as helping with athlete’s foot. It is said feet will be smoother and softer after treatment.

Worried environmental health officers in the UK contacted the HPA, which was investigating the potential risks of infection associated with the commercial use of fish spa pedicures in the UK. It said that it would examine up to date evidence of any possible risks and publish guidelines.

The BBC reported that the HPA has also said it is currently unaware of any cases of infection associated with the use of these fish spas pedicures in the UK.

The Telegraph also reported that the HPA said that while the risks from this treatment are admittedly low, even if the fish spa adheres to very stringent cleanliness regulations, they can’t be “completely excluded”.

It also quoted Dr Hilary Kirkbride, consultant epidemiologist at the HPA, who said: “Provided that good standards of hygiene are followed by salons, members of the public are unlikely to get an infection from a fish spa pedicure, however the risk will be higher for certain people.”

The HPA also explained that while the risk is ‘very low’ for healthy clients, those with conditions, including diabetes and psoriasis, or those who have weak immune systems or underlying medical conditions have now been advised against trying out this treatment.

A number of US states have banned the treatment, including Florida, Texas and Washington, due to the fear that it could be a means of spreading infection through open wounds, although so far it has not been banned in the UK, where studies were being undertaken.

These studies were being closely followed by the Health Ministry in Malta, but “until such time that we have scientific evidence of a risk, we have no plans to introduce any regulatory requirements,” a ministry spokesperson said.

The new guidance from the HPA came about after a panel found that the fish tank water contained a number of micro-organisms, the Telegraph reported, and that infections could be transmitted either from fish to person (during the nibbling process), water to person (from the bacteria which can multiply in water), or person to person (via water, surrounding surfaces and the fish).

Nevertheless the HPA did point out that it is important for salons to carry out a thorough foot examination, to check for cuts, grazes or existing skin conditions, and make sure that the client has no underlying health conditions.

It is also important that anyone wishing to try out this treatment reduces risks by giving cuts or infections time to heal, and waiting at least a day after a leg wax or shaving, as this will reduce chances of contracting an infection.