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FORTALEZA, Brazil — In this historic city by the sea in northeast Brazil, burn patients look as if they’ve emerged from the waves. They are covered in fish skin — specifically strips of sterilized tilapia.

Doctors here are testing the skin of the popular fish as a bandage for second- and third-degree burns. The innovation arose from an unmet need. Animal skin has long been used in the treatment of burns in developed countries. But Brazil lacks the human skin, pig skin, and artificial alternatives that are widely available in the US.

The three functional skin banks in Brazil can meet only 1 percent of the national demand, said Dr. Edmar Maciel, a plastic surgeon and burn specialist leading the clinical trials with tilapia skin.


As a result, public health patients in Brazil are normally bandaged with gauze and silver sulfadiazine cream.

“It’s a burn cream because there’s silver in it, so it prevents the burns from being infected,” said Dr. Jeanne Lee, interim burn director at the the regional burn center at the University of California at San Diego. “But it doesn’t help in terms of debriding a burn or necessarily helping it heal.”

The gauze-and-cream dressing must be changed every day, a painful process. In the burn unit at Fortaleza’s José Frota Institute, patients contort as their wounds are unwrapped and washed.

Enter the humble tilapia, a fish that’s widely farmed in Brazil and whose skin, until now, was considered trash. Unlike the gauze bandages, the sterilized tilapia skin goes on and stays on.

The first step in the research process was to analyze the fish skin.

“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.”

In patients with superficial second-degree burns, the doctors apply the fish skin and leave it until the patient scars naturally. For deep second-degree burns, the tilapia bandages must be changed a few times over several weeks of treatment, but still far less often than the gauze with cream. The tilapia treatment also cuts down healing time by up to several days and reduces the use of pain medication, Maciel said.

Antônio dos Santos, a fisherman, was offered the tilapia treatment as part of a clinical trial after he sustained burns to his entire right arm when a gas canister on his boat exploded. He accepted.

“After they put on the tilapia skin, it really relieved the pain,” he said. “I thought it was really interesting that something like this could work.”

The initial batches of tilapia skin were studied and prepared by a team of researchers at the Federal University of Ceará. Lab technicians used various sterilizing agents, then sent the skins for radiation in São Paulo to kill viruses, before packaging and refrigerating the skins. Once cleaned and treated, they can last for up to two years.

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.

But it may be a boon in developing countries.

“I’m willing to use anything that might actually help a patient,” Lee said. “It may be a good option depending on what country you’re talking about. But I also think the problem is that you need to find places that have the resources to actually process the skin and sterilize it, and make sure it doesn’t have diseases.”

In Brazil, in addition to the clinical trials, researchers are currently conducting histological studies that compare the composition of human, tilapia, pig, and frog skins. They are also conducting studies on the comparative costs of tilapia skin and conventional burn treatments. If clinical trials show continued success, doctors hope a company will process the skins on an industrial scale and sell it to the public health system.

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  • Don’t mutate deadly viruses and put them on an immunocompromised burn victim.

    International Journal of Medical Sciences
    2018; 15(3): 274-279. doi: 10.7150/ijms.22644
    Risks of Using Sterilization by Gamma Radiation: The Other Side of the Coin

    “Moreover, gamma radiation has been shown to generate free hydroxyl radicals and other radiotoxins. This adds additional risks of both toxigenic and mutagenic effects which could potentially induce cancer. Since several animal studies demonstrated that consummation of irradiated food provoked genome instability, new, long-term, prospective clinical studies should be conducted in near future to investigate whether irradiated food is safe for human consumption. In conclusion, more safety studies are needed to clearly define the risks of gamma radiation method of sterilization. The increased interest in newer biologics emphasizes the need for more modern sterilization methods avoiding all potential risks that gamma radiation can cause to health.”

  • SHT in Tilapia also a deadly contagious fish virus while fish farmers regularly use Chicken, Pig, &/or Duck waste to feed the tilapia in Brazil and other countries.

    Survival of LPAI H5N1 in Water Containing Tilapia zillii
    Neveen M Rizk1*et, al. 1Environmental Research Division, National Research Centre, El-Buhouth Street, Dokki, Giza 12622, Egypt. 2Microbiology Department, Faculty of Science, Ain Shams University. Available Online: 20th September, 2016,Vol8,Issue9,Article6.pdf

    Production-level risk factors for syntactical hepatitis in farmed
    tilapia (Oreochromis niloticus L)

    Kabuusu RM, Aire AT, Stroup DF,
    Macpherson CNL, Ferguson HW. Production-level risk factors
    for syncytial hepatitis in farmed tilapia (Oreochromis niloticus
    L). J Fish Dis. 2017;00:1–6.

    Tilapia lake virus, or Tilapia tilapinevirus, was identified in 2014.”

    “With regard to tilapia, some viral pathogens, including
    betanodavirus, iridovirus, and herpes-like virus (2,3), reportedly cause severe disease. ”

  • No, treatments in the US do not “require scrutiny” by “animal rights groups.” Who told you that and then bludgeoned your fact- checker?

  • We grow Tilapia for our green houses. We either sell to the fish market for consumption or to the trash. Please keep me informed as to potential markets for our fish.
    Sincerely, John Harcourt

  • Im interenst to this treatment. Im planning to do some reaserch about it. Can i have a contact person or an email to get more information about this. Thanks

  • Hello, I was wondering if you knew of any companies that are going to produce this on an industrial scale.
    Thank you,

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