Doctors in Brazil using tilapia fish skin to treat burn victims (2017)

Posted by kaycebasques 2 days ago

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Comment by osmano807 2 days ago

In my hospital we have ample experience with another technique using polypropylene sheets for defect coverage, popularized in Brazil orthopedics as "Figueiredo's technique", which is in practice an extension of common techinques for temporary closure of abdominal wall ("Bogota's bag").

We put a transparent polypropylene sheet as skin replacement, suture it directly to the skin. We can monitor the wound and its secretions, can cover exposed tendons and bones without immediate doing microsurgical flaps. For example, we can monitor the second intention skin closure with reduced infection and analgesics use, sometimes without needing a graft at all.

Comment by yndoendo 2 days ago

I was informed by a pediatric doctor they also use honey bandages for burns since it is a naturally antimicrobial and assists with cooling the body.

Comment by DerArzt 2 days ago

Modern medicine is pretty metal.

Comment by MrDresden 2 days ago

There is an Icelandic company called Kerecis that produces these kinds of fish skin based grafts. There are some videos of some of their patient's before and after over at their webpage[0] but be warned, they might be a bit graphic for some.

[0]: https://kerecis.com

Comment by ljf 2 days ago

Wow, those before and after videos really are amazing - while my own scars are tiny, they aremore noticeable than some of these fairly major wounds.

Comment by fhe 2 days ago

I thought this a pretty mature technique? I have seen more than once our local vet using this technique to treat cats with large wounds -- with great results by the way. Interestingly, they too used tilapia fish skin, and not any of the more common local fish species. I wonder if there is something special about tilapia fish skin, or it was simply the species on which the technique was developed, and nobody bothered to try using other fish species.

Comment by guessmyname 2 days ago

> I thought this a pretty mature technique? […]

Yes, it is very mature. The article was written in 2017.

Comment by jyounker 2 days ago

Tilapia are cheap and abundant, and the skin is an industrial-scale waste product.

They're incredibly hardy, and unlike most other food fish you can easily grow them in simple container setups.

Comment by deadbabe 2 days ago

Horrible to talk about a living creature this way.

Comment by fsckboy 2 days ago

(i pick mackerel at random)

A female Atlantic mackerel typically lays between 200,000 and 450,000 eggs during a spawning season. However, larger, healthier individuals can sometimes produce up to a million eggs, often in multiple batches over several weeks.

it is the mackerel themselves who consider baby mackerel lives to be industrial in scale. they produce that many in anticipation of consumption. Each foodfish humans consume has already slaughtered untold thousands of other fish to grow themselves to size.

Comment by deadbabe 2 days ago

The thrive because all the fish who laid less eggs got eaten out of extinction. They don’t anticipate anything.

Comment by mixmastamyk 2 days ago

"Fish are friends, not food"—Finding Nemo. ;-)

Comment by csours 2 days ago

"It's okay to eat fish

'cause they don't have any feelings" - Something in the way

https://www.youtube.com/watch?v=hg5behq8PlM

Comment by sublinear 2 days ago

What's special is that tilapia is probably cheaper than even the local fish since it's farmed in massive quantities and shipped all over the world as food.

If other fish skins were tried it must have been similar results.

Comment by worthless-trash 2 days ago

Tilapia imports are heavily restricted to Australia, The live fish will not be allowed, they are considered "restricted noxious fish".

The rules are:

Illegal to Keep: You cannot keep tilapia (dead or alive), sell them, give them away, or use them as bait.

Immediate Euthanasia: Humanely kill the fish as soon as you catch it.

Disposal:

Bury: Bury them deep and well away from the water's edge to prevent scavengers from dragging them back in or floodwaters from releasing eggs.

Bin: Place them in a rubbish bin.

No Filleting: You cannot take fillets and dispose of the rest; the entire fish must be destroyed.

Various state departments have hotlines for reporting tilapia.

There are different hotlines per state:

Queensland Department of Agriculture and Fisheries (DAF) (13 25 23)

New South Wales Department of Primary Industries (DPI) (1800 675 888)

Victoria (VFA) Reporting hotline (13FISH or 13 34 74)

Western Australia Dept. of Primary Industries & Regional Development (1800 815 507)

I've had rewards for reporting them (fishing reel, free bait, etc).

Comment by pwagland 2 days ago

For those that don't know why, and I didn't, the reason for this is that Tilapia are "mouth brooders", that is they keep the fertilised eggs in their mouth. So throwing away a dead female can cause these eggs to hatch, and reinfect the waters with new Tilapia.

Comment by MisterTea 2 days ago

I also hear you can dispose of them by placing them in a pan with fresh pulverized tomato, garlic, olive oil, basil, then a little lemon juice, oregano then finally, salt and pepper to taste. Highly effective, efficient and delicious.

Comment by som 2 days ago

Where I grew up (in northern Australia) a lot of people targeted and ate tilapia out of local estuaries .. there were a lot of them and they were big.

Comment by worthless-trash 2 days ago

Hello cousin (Daintree adjacent here).

Comment by MeteorMarc 2 days ago

No need for antibiotics because the fish got ample amounts while growing up in the farm.

Comment by interludead 2 days ago

It's probably a mix of "this species happens to be unusually well-suited" and "this is the species people bothered to study rigorously first."

Comment by betty_staples 1 day ago

>I have seen more than once our local vet using this technique to treat cats with large wounds -- with great results by the way.

I'm not surprised, a lot of vets I know from Iraq and Afghanistan had used Tilapias for battlefield dressing. Worst case there was a Tilapia MRE people kept around for this purpose. Honestly it's great to see them taking those skills from war and translating them into helping street animals such as cats.

Comment by primaprashant 2 days ago

They used this exact treatment in an episode of The Good Doctor, S01E06. Original air date: October 30, 2017

https://the-good-doctor.fandom.com/wiki/Not_Fake

Comment by zekrioca 2 days ago

Yes, but the treatment has been devised way prior to 2017.

Comment by ZeWaka 2 days ago

They also used it in Grey's Anatomy S15E17 (2019).

Comment by theblackknight_ 2 days ago

I was thinking same, Jared saving that girls skin after burn.

Comment by dillydogg 2 days ago

I think one of the most interesting techniques for burn victims is using placentas. I haven't seen it too much in my current hospital system, but have seen it talked about at medical association conferences and think it's pretty exciting.

Here is a gift link for an article about them in the New York Times from about a year ago.

https://www.nytimes.com/2024/10/08/well/placenta-donations-b...

Comment by dgoldstein0 2 days ago

This article is from 2017 - maybe should say so in the submission title?

Still, an interesting read

Comment by dang 2 days ago

Added above. Thanks!

Comment by interludead 2 days ago

The fact that tilapia skin was basically waste, yet turns out to have higher collagen content, better tensile strength, and better moisture retention than human skin is kind of remarkable

Comment by highhedgehog 2 days ago

My nephew had multiple heart surgery, and after the last one, he kept having the wound release liquids. For months, they just medicated the wound regularly hoping it would solve by itself. At last, they decided for a cleaning surgery, and a pediatric specialist came from Rome and apparently brought something like "fish sheets" to "cover the wound while it heals.

Comment by culi 2 days ago

tangentially related: before penicillin was formally discovered, soldiers in WW1 would use moldy slices of bread to treat their wounds (Penicillium being the most common bread mold). This or similar practices of using mold on wounds seems to date back thousands of years

Comment by vasco 2 days ago

This has been going for long enough that there's been several metastudies debunking it. Was hyped in the news around 2017.

Fish skin or silver sulfadiazine had similar effects and to me are both approximating placebo from the studies I read. The fish does nothing for pain and no difference in the scarring time vs the silver ointments.

Comment by trhway 2 days ago

fish skin (rich in collagen) sounds like a version of collagen patch. And for collagen patch for example https://pmc.ncbi.nlm.nih.gov/articles/PMC3081477/ where despite the "Conclusion" the "Results" show that it helps (and one can also expect that collagen patching is starting point to engineering artificial skin) :

Results:

With two weeks of treatment, 60% of the ‘collagen group’ wounds and only 42% of the ‘conventional group’ wounds were sterile (P=0.03). Healthy granulation tissue appeared earlier over collagen-dressed wounds than over conventionally treated wounds (P=0.03). After eight weeks, 52 (87%) of ‘collagen group’ wounds and 48 (80%) of ‘conventional group’ wounds were >75% healed (P=0.21). Eight patients in the ‘collagen group’ and 12 in the ‘conventional group’ needed partial split-skin grafting (P=0.04). Collagen-treated patients enjoyed early and more subjective mobility.

Conclusion:

No significant better results in terms of completeness of healing of burn and chronic wounds between collagen dressing and conventional dressing were found. Collagen dressing, however, may avoid the need of skin grafting, and provides additional advantage of patients’ compliance and comfort.

Comment by vasco 2 days ago

You made me go re-search for those meta studies and I can only find a brazilian one which disputes the claims but I do find a few showing benefits. I'm back to not knowing what to believe in isolation, but with results also for plasters that you shared I'm more leaning towards you being right. Thanks for sharing.

Comment by tossaway0 2 days ago

Totally anecdotal but I had a bad burn on my foot and I thought I could manage it with otc stuff. It kept getting worse so I went to have it checked out and was prescribed the silver cream.

From one day to the next it started showing positive effects and a week and a half later I was fine. I was kicking myself for waiting so long.

Comment by sva_ 2 days ago

previously:

https://news.ycombinator.com/item?id=14385336

Comment by binsquare 2 days ago

In Chinese villages, I've seen them use fish skin, potato skin, various leaves, cooked birds nest, fish fin oil, and etc to treat open wounds instead of pure bandaging.

While it's not a new technique, it's fascinating for this area to be further explored.

Comment by interludead 2 days ago

In a way this feels less like inventing something new and more like rediscovering and formalizing old techniques with modern safety constraints

Comment by screye 2 days ago

It's important in these cases to preserve the lineage of where they came from.

There's a tendency to start calling them 'western medicine' and crediting it to the person who formalized it in the west rather than the source culture where it has existed for centuries.

The conversation is bit 2010, but the point still stands.

Comment by sammy_rulez 2 days ago

It's old news. There is even “And Dream of Sheep” — Grey’s Anatomy, Season 15 Episode 17. That’s the episode where they mention using tilapia fish skin to treat burns. Original U.S. air date: March 14, 2019.

Comment by elric 2 days ago

Doesn't make it any less interesting. And in spite of it not being new, it doesn't look like it's out of the experimental stage: the article mentions it's difficult to get the tilapia skin processed and sterilized.

Comment by chipgap98 2 days ago

The article is 9 years old so that may no longer be the case

Comment by elemdos 2 days ago

Old news comes off dismissive. Doesn’t have to be a brand new discovery to be noteworthy.

Comment by sublinear 2 days ago

2019? I'm surprised they kept it running for that long.

Comment by ZeWaka 2 days ago

It's still running - season 22 right now.

Comment by petesergeant 2 days ago

And a 2017 Good Doctor episode

Comment by ycombinatrix 2 days ago

They did this in the Netflix One Piece series (with a yellowtail though)

Comment by SilentM68 2 days ago

Hmm, I remember seeing something like this mentioned in the show The Good Doctor. I forget the episode, but it deals with a patient who suffers severe burns in a bus crash and receives an experimental treatment using fish skin to aid in healing and minimize scarring. I never really felt comfortable with animal tissue being grafted to human skin. I don't believe animal tissue can be totally cleansed of contaminants. I'd rather feel more confortable with synthetic skin grafting. The movie, Darkman (1990) comes to mind.

Comment by modeless 2 days ago

I hope they verify that the recipients are not allergic to fish first. Would be nice to get a synthetic version for that reason.

Comment by max_ 2 days ago

TLDR;

Its a fantastic substitute for bandages in the sense that you don't need to take off the fish skin everyday.

Its also better are retaining moisture in the burn wounds than cotton badages.

No need for antibiotics, painkillers etc

Its also really cheap. Fish farms regard them as waste.

Comment by account42 2 days ago

> Fish farms regard them as waste.

I have only seen tilapia sold whole - the skin is one of the best parts when you fry them.

Comment by subscribed 2 days ago

Same here. Not with just tilapia, but pretty much every fish.

Comment by AdmiralAsshat 2 days ago

How expensive is the sterilization process, though? That would be my primary concern if tilapia-skin bandages started to get widely available/mass-produced: that unscrupulous vendors would cut corners during sterilization, and then the burn victims would get nasty infections from remnant bacteria on the tilapia skin.

Comment by Scoundreller 2 days ago

Dunno what method they use, but gamma irradiation is pretty cheap at scale

Comment by conductr 2 days ago

I think any farmed animal is or should have no waste. Even if it’s turned into cat food the skin is most definitely not just waste, there’s uses out there. However, if it is as cheap and readily available as cat food then that’s great for burn victims too.

Comment by sMarsIntruder 2 days ago

> In the US, animal-based skin substitutes require levels of scrutiny from the Food and Drug Administration and animal rights groups that can drive up costs, Lee said. Given the substantial supply of donated human skin, tilapia skin is unlikely to arrive at American hospitals anytime soon.

This reminds me of Milton Friedman’s arguments against the FDA.

Comment by lukebitts 2 days ago

I wonder what’s the difference between countries that drives that. It’s not like Brazil doesn’t have its own FDA, which is much more strict than the US one, from what I know. Maybe some kind of lobbying? Or are animal rights group that much stronger?

Comment by skissane 2 days ago

I was having a conversation about this with my father-a retired pharmaceutical industry executive-a few weeks back, about why certain generic prescription medication formulations were unavailable in Australia yet sold in New Zealand. He explained to me that the Australian pharmaceutical regulator (the TGA) and its New Zealand equivalent (Medsafe) had very different regulatory philosophies. Medsafe, if a major international regulator (such as the US FDA or the EU’s EMA) had already approved something, they’ll just approve it too (“if it is good enough for them it is good enough for us”); the TGA’s attitude was very different, just because the FDA or EMA had approved it didn’t mean they automatically would, they wanted to analyse the safety data for themselves and make up their own mind. For blockbuster patented drugs, the extra regulatory cost of Australia was worth it, but for the long tail of miscellaneous generic formulations, the extra cost of dealing with the TGA could make some of them financially nonviable.

Comment by tehjoker 2 days ago

Medsafe's strategy only works so long as there is at least one stringent regulator though.

Comment by AuryGlenz 2 days ago

I would think for a country like Australia a more moderate approach would be to approve things that were approved by other countries and have been in use for some amount of time - say, 5 years or so - apart from the things they directly approve.

Comment by skissane 2 days ago

The actual drug my father and I were discussing was clonidine.

In the UK and New Zealand, they sell 25 microgram clonidine tablets; in Australia, the smallest dose on sale is 100 micrograms.

Clonidine is a very old drug – it was released back in the 1960s. The risks involved are very well understood (arguably the biggest risk is fatal overdoses, but patient/parent education is the accepted mitigation strategy.)

The issue is, in Australia, it is only approved for treating high blood pressure in adults. Paediatricians and child psychiatrists commonly prescribe it for ADHD, and for anxiety, aggression and insomnia (particularly but not exclusively in the context of ASD); in adults, it is prescribed to treat menopausal hot flushes and migraines – but all those indications are off-label.

And this is the problem – given the doses involved, 25 microgram tablets only really make sense for those off-label indications, there isn't much demand for them for treating adult hypertension. So to get the TGA to approve 25 microgram clonidine tablets, you need to prove to them that clonidine is safe and effective for one of those currently off-label indications. And that will cost a lot of money, and given it is a generic medication long out of patent protection, it isn't worthwhile. Whereas Medsafe quite possibly just decided "the UK approved it for X so we will too".

As a parent, both of whose children are prescribed clonidine, this annoys me – cutting tablets in half is no fun, and cutting them into quarters is even worse. Or I can get them compounded into liquid by a compounding pharmacist, which makes it easier to measure out smaller doses (I always get 25 microgram/ml), but that adds expense and time (the nearest compounding pharmacy is 15 minutes drive one way). I just wish I could get 25 microgram tablets, but they can't legally be sold in Australia–possibly I could ask our child psychiatrist to apply for special permission to import them from New Zealand, but the amount of bureaucracy involved probably isn't worth it, there's no guarantee the request would be approved, and it would be expensive (it wouldn't be covered by our national prescription drug insurance).

Comment by MattGaiser 2 days ago

I imagine it is about this:

> But Brazil lacks the human skin, pig skin, and artificial alternatives that are widely available in the US.

This is not an improvement on existing methods (it may end up being, but that is not the motivation) but rather a case of it being all they have to work with.

Tilapia skin is probably better than no skin at all.

Comment by hu3 2 days ago

> This is not an improvement on existing methods... a case of it being all they have to work with.

But the article says Tilapia skin is better in multiple aspects:

> "We got a great surprise when we saw that the amount of collagen proteins, types 1 and 3, which are very important for scarring, exist in large quantities in tilapia skin, even more than in human skin and other skins," Maciel said. "Another factor we discovered is that the amount of tension, of resistance in tilapia skin is much greater than in human skin. Also the amount of moisture."

Comment by dmurray 2 days ago

It says it's different to human skin in multiple aspects.

Do I need more collagen or more moisture in my skin? I would expect evolution made some pretty good choices around default human skin for typical human activities, and if more moisture was obviously good, I would already have it.

Maybe tilapia skin is better for people who spend 24 hours a day swimming in lakes.

Comment by hu3 2 days ago

> It says it's different to human skin in multiple aspects.

No it says "even more than in human skin and other skins". Not different.

> Do I need more collagen or more moisture in my skin?

For this context? Yes? Clearly the article answers that already. I even included in my first reply but you'll have a third chance to read it:

> ...which are very important for scarring...

And your attempt to move the goal post fails miserably as well. Or do you think humans evolved to perfection by thinking this:

> I would expect evolution made some pretty good choices around default human skin for typical human activities, and if more moisture was obviously good, I would already have it.

I don't think you are debating in good faith. Good luck.

Comment by Qem 2 days ago

> It’s not like Brazil doesn’t have its own FDA, which is much more strict than the US one, from what I know.

Unless we are talking about pesticides, where Brazil is effectively dumping grounds for substances banned in EU. Every time some pesticide is forbidden in Europe, brazilian regulators are happy allowing local agribusiness import it by the ton in fire sales: https://www.brasildefato.com.br/2025/10/14/export-grade-pois...

Comment by kylehotchkiss 2 days ago

Is this a stem cell thing or a growth factor/morphogens thing?

Comment by throwaway290 2 days ago

(2017)

Comment by jenders 2 days ago

They do this in Iceland too

Comment by nextaccountic 2 days ago

> Mar 3, 2017

Title needs (2017)

Comment by gaptoothclan 2 days ago

great news for humans, bad news for fish

Comment by kiernanmcgowan 2 days ago

I've read Dune - I know exactly where this is going. Please do not apply sand trout directly to you skin unless you are ready to control the spice.

Comment by jyounker 2 days ago

The God Emperor of Brazil would be a brilliant satire. I look forward to the new fish speakers.

Comment by DHRicoF 2 days ago

The power to destroy a thing is the absolute control over it.

Comment by 2 days ago

Comment by aaron695 2 days ago

[dead]

Comment by poopster 2 days ago

i saw that episode of one-piece

Comment by RobotToaster 2 days ago

Will never be approved by the US FDA since it can't be patented.

Comment by ZeWaka 2 days ago

Kerecis got FDA clearance in 2013, and then approval in 2016.

Comment by RobotToaster 2 days ago

That's made from cod, and it appears they chemically modified it so that it can be patented https://www.kerecis.com/kerecis-receives-u-s-patent-for-fish...

Comment by groundzeros2015 2 days ago

You mean because nobody will pay the cost to go through FDA process without profit incentive?

Comment by 01100011 2 days ago

I'm pretty sure they've done this for decades. I seem to remember someone using potato skins like 30 years ago.

Comment by guessmyname 2 days ago

> I'm pretty sure they've done this for decades […]

Yes, the article you read is from 2017.

Comment by 01100011 2 days ago

No, I'm saying I think it's even farther back than that. I think the article from 2017 is like the article from today. It's presenting something old as something novel.

Comment by motbus3 2 days ago

This is quite old news. I've heard about this more than 10 years ago at least. It has been fairly successful since the beginning and I've heard it improved quite a lot