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By nurul980117 | Updated: Sept. 30, 2019, 1:09 p.m.

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SITI NURUL ASYIQIN BT MUHAMAD 
         (2018635024)
Ichthyotherapy

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DEFINITION
> Ichthyotherapy is the use of fish such as Garra rufa for cleaning skin wounds or treating other skin conditions. The name ichthyotherapy comes from the Greek name for fish – ichthys. The most widely known form of ichthyotherapy is used in the treatment of skin conditions and involves the Garra rufa, commonly known as doctor fish or nibble fish.

>Ichthyotherapy also defined as the treatment of skin disease such as psoriasis and ichthyosis with the so-called “doctor fish of Kangal”.
Garra rufa are native to the Middle East, where they have been used as a medical treatment for individuals with skin diseases. One study has illustrated the effectiveness of fish pedicures in the treatment of psoriasis.

1)  Doctorfish of 'Kangal’
1) Psoriasis is a common skin disorder with a worldwide distribution. There is no cure, and no simple, safe and invariably effective treatment for this disease . The disease carries a substantial burden even when not extensive. Some patients rely on conventional pharmacological methods and others try alternative and complementary treatment modalities.
2) Surely one of the most unusual alternative treatments is the so-called ‘Doctorfish of Kangal’ in the Central Anatolia region of Turkey. This treatment was first mentioned in The Lancet in 1989 but the details of the treatment were published only recently by Özcelik et al.  
3)Two different types of fish live in the pools of the Kangal hot spring such as Cyprinion macrostomus and Garra rufa. Both fish are members of the carp and minnow family (Cyprinidae). 
4) Garra rufa is regarded as the main therapeutic. Garra rufa is normally a bottom dweller, where it adheres by suction to rocks with its ventral crescent-shaped mouth to feed on phyto- and zooplankton 
2) treatment tubs
1) The treatment tubs, made from food-safe plastic had a capacity of 1100 l. Between 250 and 400 fishes were used, depending on the size and severity of the skin lesions.Treatment lasted 3 weeks. A daily 2 h ‘fish bath’ was taken in a bathtub at a comfortably warm temperature (36–37°C). Patients with no contraindication to UV exposure (reported history of UV-related skin malignancies) used a commercially available stand-up rapid-tan facility (Cyclone 60 with 60 Cosmolux VHR160 lamps, CMC Sun Capsule USA) for 3–5 min after each bath session according to skin type. 
2) The spectral emission of the lamps. After UV exposure, the patients applied a generic skin lotion (Pharmacy Neunkirchen, Austria) containing glycerine, Butyrospermum parkii (Shea butter) and Aloe vera extract. If psoriasis lesions severely involved the scalp, the patient's head was shaved before treatment. 
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 The bathtubs were equipped with an elaborate fresh water system.  
The water was exchanged completely 3 to 4 times a day.  
The fish, reared in an adjacent breeding facility, ranged from 5 to 10 cm in length (∼1.5 years old) when used for treatment. 
 After the 3 week treatment, each tub along with the technical equipment was disinfected. 
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the Advantages of treatment tubs
> A fish pedicure, also known as a fish spa, involves patrons dipping their feet in a tub of water filled with small fish called Garra rufa.

> Garra rufa eat away dead skin found on peoples’ feet, leaving newer skin exposed.
Have two types of patients
A patients diagnosed with psoriasis who underwent 3 weeks of ichthyotherapy combined with a short course of UVA sunbed treatment at an outpatient treatment facility in Lower Austria . 
Add Text
> Patients had moderate to severe chronic plaque psoriasis. Patients referred themselves to the treatment facility to find relief from their symptoms. 
  >The costs of this treatment were not covered by the patients' health care insurance. All patients had signed informed consent and were under constant medical supervision throughout the course of treatment.
Conclusion  !
In summary, the observed benefit, along with the favorable safety profile, suggests that ichthyotherapy combined with a short course UVA treatment could provide a viable treatment option for patients with psoriasis vulgaris. Prospective controlled studies are now warranted to validate the efficacy of this unusual treatment modality. 
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References 
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http://biotherapysociety.org/ichthyotherapy/

https://www.cdc.gov/healthywater/hygiene/body/fish_pedicures.html
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1697753/
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