AS EVER more Singaporeans flock to fish spas over the years, the question remains: Is it a fresh idea or foul?

Earlier this month, two American states, Texas and Washington, banned fish spas, citing the risk of infections, though there were no known complaints there. They said there was no way to be sure that either the fish or the tanks were sanitary.

Here, online forums are abuzz about the value of the treatment. While some forum contributors said their skin became smoother after the spa, others felt the effects were no better than a skin exfoliating scrub.

Over the past two years, an estimated 20 shops have sprung up in Singapore where people go to submerge their hands and feet in a "fish bath", to have small toothless Garra rufa fish nibble away their dead skin.

The benefits are said to be smoother skin and the alleviation of skin problems. But the curative properties of the treatment are not proven.

One pilot study, conducted by Dr Martin Grassberger of the Medical University of Vienna, found that most patients with psoriasis, a condition that causes red scaly patches to appear on the skin, did find some relief from their symptoms after the supposed therapy.

But these patients took two-hour daily "fish baths" for three weeks that were combined with ultraviolet radiation therapy.

The fish spa idea originated in the Kangal hot springs in Turkey, where it is said that a shepherd discovered in 1917 the therapeutic effects of having skin nibbled on by Garra rufa fish (below).

But the water temperature there is a mean 36 deg C, and bathers are exposed to natural ultraviolet radiation because of its altitude of 1,650m, factors that may influence the therapeutic effects.

Another widely publicised trait of the Garra rufa fish, that it secretes an enzyme believed to aid skin rejuvenation, has not been proven.

(Page 1 of 2)Ms Nancy Lim, president of the Spa Association Singapore, warned against fish spas, saying they were "just another new marketing tool to attract new clients".

But Mr Prince Wong, managing director of Princes Association, which supplies fittings and fish for such businesses, said it was a fun activity. "Fish spas are meant to promote family bonding."

Still, experts said there are some things to watch out for. Dermatologist Patricia Yuen warned that cuts and wounds that come into contact with the water could become infected.

Those with skin problems, such as eczema, should also avoid soaking their skin for a prolonged period.

Operators of such spas contacted said they check that their customers do not have open wounds.

They added that they use filtration systems and ozonisers to keep the water clean and ultraviolet light to kill bacteria.

Such methods would usually kill most bacteria, confirmed Professor Sanjay Swarup from the National University of Singapore's Department of Biological Sciences.

The problem: Not all fish spas may be hygienic or use the right kind of fish. According to Mr Wong, about 50 per cent of shops do not use the Garra rufa, but lookalikes in the Garra family, or the Chin Chin (below), a biting fish that may cause micro-damage to the skin.

The Straits Times checked four shops and found one passing off the wider-bodied Chin Chin as the slender-body Garra rufa.

Still, complaints against fish spas here are rare.

This year, the Consumers Association of Singapore (Case) received one questioning the therapy's effectiveness in treating skin ailments, while The New Paper ran a story on two sisters who said they caught a fungal infection after visiting a fish spa.

Case executive director Seah Seng Choon advised consumers to exercise caution when using fish spas and to seek medical consultation for skin conditions.

ayiying@sph.com.sg

This story was first published in The Straits Times on Oct 29, 2008.

For more The Straits Times stories, click here.

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