FISH SKIN FOR BURN WOUNDS: THE FUTURE WOUND DRESSING?

According to the WHO, nearly 180,000 individuals die of burn injuries each year. More than 10 million get severe burns and require medical care. Those are big numbers.

Burns are a very common type of injury that can lead to scarring, deformity, disability, and death. Doctors and researchers are always working on developing better ways to treat burn victims and give them the best functional and cosmetic outcomes.

Impeccable wound care and skin grafting have been the cornerstone of burn wound treatment. In recent years, researchers in Brazil have started using fish skin as a biological dressing to help heal wounds faster and reduce pain.

The Tilapia fish skin is currently being studied and used in Brazil, and it has shown excellent results. It’s cheap, reduces pain, and speeds up healing. So, will fish skin be the new trend in treating burn wounds?

How It Started

The main reason behind using fish skin was the lack of enough donor human skin grafts in a developing country like Brazil. Compared to more advanced countries, like the USA, Brazil has a less robust organ donation program. Hence, many burn victims do not receive skin grafts or have to pay astronomical amounts of money to get a donor graft.

The Tilapia fish skin is very cheap to produce. Tilapia are very commonly grown in fish farms all around Brazil, and the skin is a waste product that is usually thrown away. This means that it is very cheap to acquire and develop for medical use.

And this is exactly what researchers at the Federal University of Ceará did.

They used Tilapia fish skin to treat burn wounds in a 23 year old Brazilian man who was injured by a gunpowder explosion. The fish skin was applied to his arms and hands and then covered with gauze. The treatment led to fast and very effective healing

Tilapia fish skin applied onto the left arm (Image 1). The results after 17 days (Image 2). 
Lima-Junior EM, de Moraes Filho MO, Costa BA, et al. Innovative treatment using tilapia skin as a xenograft for partial thickness burns after a gunpowder explosion. J Surg Case Rep. 2019;2019(6):rjz181. Published 2019 Jun 14. doi: 10.1093/jscr/rjz181

Why Fish Skin? 

This is probably the first question that comes to mind when hearing about this. 
The skin of the Tilapia fish is very similar to that of humans, and maybe even better. It was observed to improve the healing process and reduce pain effectively in burn victims. But why is that?

Here are the things that make fish skin great for burn wound healing: 

• Contains high levels of collagen type 1, which promotes healing and encourages structural cells to develop in the wound.
• Contains a large amount of Omega-3 fatty acids, which have great antibacterial and antiviral properties, making fish skin strongly protective against infection. 
• Contains a wide variety of amino acids, which stimulate cell and tissue regeneration, reduce inflammation, fight off bacteria, and protect the nerve endings. 
• Contains special healing peptides (tilapia piscidin-3 or TP3) that speed up cell proliferation, remodeling, and maturation of infected wounds.
• Adheres firmly to the wound
• Holds moisture very effectively 
• Tense and resistant, allowing great protection of the wounds
• Cheap and readily available 

All these characteristics of fish skin make it a promising tool for treating moderate and severe burns. It can replace regular gauze dressing and improve the outcomes. Doctors in Brazil have been able to demonstrate this through their research (see below). 

How it Works 

Tilapia fish skin is not just taken off the fish and thrown on the wounds of burn victims. 

First, the skin is collected, cleaned, treated chemically, and irradiated. After that, it’s tested to make sure it is sterile, and finally, it’s put in specialized packaging ready to be used. 

• The fish skin is used as a biological dressing for the wound. It’s applied directly on the burn wounds to cover all the exposed tissue and part of the healthy skin. 
• There’s no need to add any extra creams (like silver or sulfadiazine) 
• The fish skin is covered by sterile gauze 

During the healing process, the Tilapia fish skin will adhere firmly to the exposed skin. This provides excellent protection against external insults. The numerous proteins and fatty acids will infiltrate the wound and stimulate healing. 

For superficial wounds, there might be no need to change the fish skin. It can be left there until the skin regenerates on its own, and the fish skin sloughs off. 

For deeper wounds that require weeks to heal, fish skin dressings might need to be repeated a few times before the skin fully heals. Nevertheless, dressing changes are much less often than with regular gauze and creams. 

Latest Research 

New research has recently demonstrated the great benefits of fish skin in treating burn wounds. Fish skin has shown to be superior to routine management with gauze and burn creams. 

The research group that originally suggested Tilapia fish skin as a possible treatment for burn wounds has recently published the results of a clinical trial that involved 115 burn victims in Brazil. 

The Phase III results, published in the journal “Plastic and Reconstructive Surgery” last May, showed that using fish skin for burns:

• Speeds up the healing process (re-epithelialization) 
• Reduces the frequency of wound dressing changes 
• Reduces pain and the need for painkillers 
• Reduces the costs of treatment significantly 

From what we know so far, fish skin might not only be a solution for countries with skin graft shortages. It might be the future of burn wound treatment. Some companies, like Kerecis in Iceland, have even developed Codfish skin for use in burn victims.

With faster healing and reduced pain, fish skin might soon replace conventional wound dressing altogether. 

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Sources: 

• https://www.biodermis.com/blogs/biodermis-blog/tilapia-skin-and-other-burn-treatment-techniques-biodermis-com
• https://www.reuters.com/article/us-health-brazil-burns-idUSKBN18L1WH
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6565829/
• https://clinicaltrials.gov/ct2/show/NCT04202289
• https://www.pbs.org/newshour/health/brazilian-city-uses-tilapia-fish-skin-treat-burn-victims
• https://www.miamiherald.com/news/nation-world/world/article223954635.html
• https://www.nebraskamed.com/burn-care/fish-scales-used-to-heal-burn-injuries
• https://journals.lww.com/plasreconsurg/Abstract/2021/05000/Nile_Tilapia_Fish_Skin_Based_Wound_Dressing.27.aspx
• https://blogs.unimelb.edu.au/sciencecommunication/2020/10/11/an-innovative-but-fishy-treatment-of-burns/
• https://academic.oup.com/jscr/article/2019/6/rjz181/5518403
• https://www.ecronicon.com/ecve/pdf/ECVE-05-00209.pdf
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6565829/
• https://www.who.int/news-room/fact-sheets/detail/burns

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