I haven’t seen fish pedicures in the news for a while in the U.S., but apparently they are gaining popularity in France. A French agency for occupational health and safety is calling for “strictly regulating” the service to prevent the risk of infection to users and professionals, the agency, ANSES, said in a news release.

As a growing import from Asia and the Middle East, an increasing number of establishments in France are offering the pedicure, in which clients place their feet into a tub containing small carp that eat away dead skin. In France, fish pedicures are not governed by any specific health regulations. ANSES was asked by the French Ministry of Health to carry out a risk assessment on the possible transmission of diseases via fish or the water.

In its appraisal, ANSES made the following assertions:

> Since 2010, fish pedicures have become increasingly available in Europe. “It’s not possible to determine the extent of this practice in France with any precision but it would seem that several hundred establishments offer fish pedicures,” ANSES says, of which only a few dozen satisfy the applicable legal requirements for the protection of animals in captivity.
> Cases of bacterial infection linked to fish-keeping and fish pedicures have been described.
> There is little information available about the quality of the water in establishments practicing fish pedicures and no data specifically about the presence and prevalence of pathogenic micro-organisms in the fish sold in France.
> It is not possible to keep the water adequately disinfected in tanks used for fish pedicures, as this would kill the fish present.
> There is a higher risk of infection with certain groups of users (diabetics, the immune-compromised, users with dermal lesions on the feet).
> People with excessively thick skin (hyperkeratosis), sometimes caused by mycoses, may be especially drawn to fish pedicures, therefore increasing both the risk for these individuals who suffer from higher sensitivity to infection, and the risk of water contamination in general due to their mycoses. 

ANSES deems it necessary to regulate fish pedicure practices with suitable provisions to ensure:
> that fish pedicure tanks contain water that guarantees protection of users against the risk of infection
> admission procedures and user hygiene, with the hygiene of the establishment being under the responsibility of qualified personnel
> both inspection and self-monitoring of the facilities and their operation, in terms of water quality in the tanks and the general hygiene of the establishment
> mandatory traceability of batches and health inspections of the fish
> objective public information about the potential risks of this practice
> information for personnel, including temporary staff, trainees, and the staff of outside companies working within the establishment, on the risks of infection, especially by multiple antibiotic-resistant strains of bacteria, and the need to comply with workplace hygiene rules
> training for the personnel of these establishments to ensure their safety and that of users

—Sree