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Ichthyotherapy
Ichthyotherapy is the  method of treatment of the skin disease named psoriasis, which originated from Kangal, Turkey. This is a special method of treatment using the fish Garra rufa, also called doctor fish of Kangal. Psoriasis is a common worldwide skin disease prevalent especially in Europe and USA (2%). The word ichthyotherapy is derived from the Greek word 'ikthus' meaning fish. Garra rufa  is a special type of bottom dwelling fish, where it adheres by suction to rocks with its ventral crescent-shaped mouth to feed on phyto- and zooplankton. These fishes are found indigenously in the hot springs of Anatolia region of Turkey. This treatment was first discussed in The Lancet in 1989 (5), although Zcelik et al. published the details of the treatment recently. The term ichtyotherapy was introduced by Grassper and Hoch in 2006. This method follows the same biomedical principles as used in hirudotherapy (use of leeches), maggot therapy (use of maggots), etc.

However, in the hot pools of the Kangals, these fish mainly feed on the skin of the bathers, which in turn helps them recover from skin diseases like psoriasis and atomic dermatitis. Ichthyotherapy is a growing and famous method of treatment for many incurable skin diseases. It is widely used nowadays all over the world. This method is gaining more commercial importance with the introduction in the cosmetic industry, such as fish spas.

Factors affecting treatment
The use of ultra violet rays is reported to be effective in combination with ichthyotherapy in the form of a sunbed or in natural form. During the treatment, Garra rufa removes skin scales, increasing the penetration of direct UV rays into the skin of patients.

The high level of selenium in Kangal hot spring water is suggested as one of the factors increasing the efficiency of ichthyotherapy. However, the presence of selenium may not be a major factor in ichthyotherapy effectiveness because the same efficiency has been reported with water containing a relatively lower level of selenium.

Oral secretions are also suggested as one of the reasons for ichthyotherapy's effectiveness. Such substances as crinotoxins, calmodulin, and pheromones, along with fatty acids, immunoglobulin, lectin, lysozyme, and proteolytic enzymes, are contained in the mucus of Garra rufa. All of these substances have an antibacterial effect, which results in the prevention of colonization by pathogens.

Some of the ichthyotherapy providers state that Garra rufa is able to produce a unique enzyme called dithranol. However, there is no scientific evidence that proves this statement.

G. Ruffa
According to information published by the author of "The Lancet", two different species live in the pools of Kangal: Garra rufa and Cyprinion macrostomus. However, Garra rufa is mainly used in the treatment of skin diseases. The reason for this is Garra rufa is a bottom dweller, which results in specific ventral crescent-shaped mouth, in order to feed on zoo- and phytoplankton. These plankton species are scarce during the spring, resulting in feeding on skin scales of patients. This process effectively reduce such skin diseases like psoriasis. As could be seen, Garra rufa fishes prefer hyperkeratotic skin over healthy skin, since it is much easier to remove the scales on skin of people suffering from skin diseases.

Habitat
Garra rufa is found in the hotspots and lakes of Turkey, Syria, Jordan, Israel, Palestine, Iraq, and Iran. These fish are also commonly found in the Kzl, Seyhan, Ceyhan, Orontes, Queiq, Jordan, Tigris–Euphrates, Kor, and Mond river basins, but the species also inhabits other coastal river basins in the Levant and Iran. It is found mainly in lakes, reservoirs, ponds, and canals and is found abundantly in heavily human-polluted waters. Although these fish are normally not found in stagnant waters.

Morphological and genetic species
This includes G. turcica (formerly a subspecies) from its Turkish range, except the Tigris–Euphrates system, G. jordanica (new species) from the northern Dead Sea basin, including the Jordan River, in Israel, Jordan, and Syria, G.

This species' classification has been labeled as "uncertain". There are some morphological changes over its somewhat vast range as traditionally characterized (sensu lato), and it has been recognized for several years that it is most likely a species complex. Several subspecies have been described, but their validity is debatable, and authorities have typically refused to accept them in recent decades. Although reviews published in 2014 recognized some of them as separate gymnothorax (formerly a subspecies) from the Karun, Balarud, and Bashar systems in Iran, G. Mondica (new species) of the Mond River basin in Iran, and G. Amirhosseini (new species) from the Sartang-e-Bijar Spring in the Tigris River system in Iran.

Psoriasis
Psoriasis is a common long-term non-curable skin disease that causes red, itchy, scaly patches on the skin. It's most common in the knees, elbows, trunk, soles of feet, and scalp. Common symptoms include red patches on skin, dry skin that may bleed, itching and burning.

Some common types of psoriasis are plaque psoriasis, nail psoriasis, guttate psoriasis, inverse psoriasis, pustular psoriasis, erythrodermic psoriasis, and psoriatic arthritis. Psoriasis is assumed to be a problem with the immune system which causes the skin to regenerate at a quicker rate than normal. This high turnover of cells causes scales and red areas in plaque psoriasis, the most common kind of psoriasis.

It's not totally apparent what causes the immune system to malfunction. Both genetics and environmental variables are thought to have an impact, according to researchers. However, this condition is not contagious.