Psoriasis Treatment in Turkey: Doctor Fish, Thermal Springs, Biologics — What Actually Works
Short answer: Turkey's doctor-fish spring at Kangal and its thermal baths can make plaques look and feel better for a few weeks, but the evidence comes from small, uncontrolled studies and the effect is temporary. What controls psoriasis in the long term is the same everywhere: a dermatologist's assessment of severity and joints, then a stepwise plan of topical treatment, phototherapy, tablets or biologics. If you come to Turkey, come for a diagnosis and a written plan you can continue at home.
“Is it worth travelling to Turkey for psoriasis?” is a question people ask in many languages. This article answers it honestly: what the fish and the thermal springs can and cannot do, what a dermatology visit actually involves, and how to keep treatment going once you are home. For the disease itself — types, triggers and treatment steps — see my page on psoriasis: causes, types and treatment.
Kangal doctor fish: what the studies show
Kangal is a hot spring in Sivas province, in central Turkey, where small fish (mainly Garra rufa) nibble the scale off psoriatic plaques. A typical stay lasts two to three weeks, with several hours a day in the water, often combined with sunbathing.
The evidence is thin:
An uncontrolled Turkish study followed 87 patients over 21 days. PASI scores fell significantly, but there was no comparison group, and many patients were no longer in the study by the final check.
An Austrian pilot study of 67 patients combined two-hour fish baths with short daily UVA exposure for three weeks and reported a mean PASI reduction of about 72%. Because ultraviolet light was part of the treatment and the study was retrospective without a control group, the fish's own contribution can't be separated.
Claims of longer remission rest on small numbers and patient recall, not on long-term controlled follow-up.
Removing scale makes plaques look flatter and lets light reach the skin, and warm water, rest and sunshine help too. That is real relief, but it works on the surface, not on the immune process underneath. Psoriasis is a chronic immune disease: when any treatment stops, plaques usually return sooner or later, and there is no good evidence that fish therapy is an exception.
Hygiene and infection risk
Fish can't be disinfected between bathers. Garra rufa shipped to the UK for spa and pedicure use were found to carry bacteria able to cause infections in people, and case reports describe skin infections after fish pedicures. The risk is higher if you have open or cracked plaques, diabetes or poor circulation, or if you take methotrexate, ciclosporin or a biologic. In those situations, ask your dermatologist before booking a fish spa.
Thermal springs, sun and sea
Turkey has many thermal spas, and some people with psoriasis feel better after a stay. Studies of spa therapy (balneotherapy) are mostly small and usually mix bathing with sunlight or UV, so it is hard to say which part helps. Guidelines treat it at most as an add-on, not as a replacement for medical treatment.
Sun helps many plaques, but sunburn can trigger new ones at the burned site. Phototherapy — measured doses of UV under medical supervision — is the evidence-based version of the same idea.
What a dermatologist actually does at the first visit
Confirms the diagnosis. Scalp, nail and fold psoriasis are easily confused with seborrhoeic dermatitis, eczema or a fungal infection. Dermoscopy, and sometimes a scraping or biopsy, settle it. More on the scalp: scalp diseases.
Measures severity. PASI (Psoriasis Area and Severity Index), BSA (percentage of body surface affected) and the DLQI quality-of-life questionnaire give a baseline. A score above 10, or involvement of the face, scalp, nails, palms or genitals, often means systemic treatment is worth discussing.
Asks about joints. Morning stiffness lasting more than 30 minutes, a whole swollen finger or toe, or heel and lower-back pain can mean psoriatic arthritis, which needs early treatment, often together with a rheumatologist.
Looks at the wider picture. Weight, blood pressure, blood sugar, lipids, smoking, alcohol and mood all influence psoriasis and the choice of treatment.
Reviews triggers and previous treatments: what worked, what didn't, and why it was stopped.
Treatment options, step by step
Topical treatment
For limited psoriasis: corticosteroid creams, ointments, foams or shampoos of the right strength for each area; calcipotriol (a vitamin D analogue), alone or combined with a steroid; and calcineurin inhibitors such as tacrolimus for the face and skin folds. Topical treatment often fails because too little is used, for too short a time, or in the wrong form for the area.
Phototherapy
Narrowband UVB is well documented for widespread plaques. It needs two to three sessions a week over several weeks, so it is usually more practical close to home.
Tablets
Methotrexate, ciclosporin, acitretin, dimethyl fumarate, apremilast (a PDE4 inhibitor) and deucravacitinib (a TYK2 inhibitor) are options for moderate to severe disease. Each needs regular monitoring, and some are not suitable during pregnancy or when one is being planned.
Biologics
Biologics are injections given every few weeks to months that block specific inflammatory signals: anti-TNF, anti-IL-17, anti-IL-23 and anti-IL-12/23 antibodies. They have changed what people with severe psoriasis can expect, and many reach clear or almost clear skin. Before starting, tuberculosis and hepatitis B and C are ruled out and vaccinations are reviewed; during treatment, infections are watched for.
Access and reimbursement conditions in Turkey can change; whether a specific medicine is suitable for you is assessed at the consultation.
Treated in Turkey, continued at home
One visit, one written plan. Diagnosis, severity scores, joint screening and a plan written in English with active-substance names, so any doctor can read it.
Prescriptions. A Turkish prescription is filled in Turkish pharmacies. Turkey is outside the EU's cross-border prescription system, so in practice a doctor in your country usually prescribes from the written plan. How supply will continue is agreed before anything is started.
Laboratory monitoring. Blood tests for methotrexate, ciclosporin or biologics can be done in a local laboratory; you send the results and photos of your skin by WhatsApp.
Contact between visits. Questions, side effects and flares go through WhatsApp; a follow-up visit is planned when the response needs to be assessed in person.
Shared care. If regular travel isn't realistic, the safest option is follow-up with a dermatologist near home, using the same plan.
Before you travel: send photos first
Send these by WhatsApp before you book travel:
Daylight photos of the plaques, scalp, nails and any painful or swollen joints
A list of current and previous treatments, with active-substance names and how long you used them
Recent blood tests, if you have them
Other conditions and medicines, and whether you are pregnant or planning a pregnancy
From this I can tell you whether the trip makes sense and what will happen on the day, and give you information in euros before you travel. The diagnosis and the final plan are made at the examination. My practice is in Kırklareli, near the Bulgarian and Greek borders, about 45 minutes from Lüleburgaz and 1 hour from Edirne. More on the process: how we work with international patients.
When to see a doctor without delay
Red, inflamed skin over most of the body, or sudden widespread pustules with fever: seek medical care locally the same day — don't plan a trip for this.
Painful or swollen joints, or morning stiffness that lasts.
Plaques that don't respond after a few months of correctly used topical treatment.
Fever or signs of infection while taking methotrexate, ciclosporin or a biologic.
Pregnancy, or planning one, while on systemic treatment.
Frequently asked questions
Does the Kangal fish spring cure psoriasis?
No. Small, uncontrolled studies show that plaques improve during a two- to three-week stay, partly because sunlight is part of the treatment. There is no evidence that it changes the course of the disease, and plaques usually return over time.
Is a fish spa safe if I have psoriasis?
The fish can't be disinfected between bathers and can carry bacteria that infect people. Avoid fish spas if you have open or cracked plaques, diabetes or poor circulation, or take immune-suppressing medicine, and ask your dermatologist first.
Can I start a biologic in Turkey and continue it at home?
Sometimes, but it has to be planned. Screening tests come first, the plan is written with active-substance names, and supply and monitoring at home are arranged before the first dose. Access and reimbursement conditions differ between countries and are assessed individually.
How long do I need to stay in Turkey for psoriasis treatment?
A first assessment usually takes a single day: examination, severity scoring and a written plan. Phototherapy needs sessions two to three times a week for several weeks, so it is normally done close to home.
Do sun and sea water help psoriasis?
Many people improve in summer, mainly because of ultraviolet light. Sunburn can trigger new plaques, so gradual exposure matters. Phototherapy under medical supervision is the measured, reliable version of the same effect.
Can I send photos before travelling?
Yes. Daylight photos of plaques, scalp and nails, a list of previous treatments and recent blood tests sent by WhatsApp let me tell you whether the trip makes sense. The diagnosis and final plan are made at the examination.
References
Nast A, Smith C, Spuls PI, et al. EuroGuiDerm Guideline on the systemic treatment of Psoriasis vulgaris – Part 1: treatment and monitoring recommendations. J Eur Acad Dermatol Venereol. 2020;34(11):2461-2498. DOI
Menter A, Strober BE, Kaplan DH, et al. Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with biologics. J Am Acad Dermatol. 2019;80(4):1029-1072. PubMed
Özçelik S, Polat HH, Akyol M, et al. Kangal hot spring with fish and psoriasis treatment. J Dermatol. 2000;27:386-390. PubMed
Grassberger M, Hoch W. Ichthyotherapy as alternative treatment for patients with psoriasis: a pilot study. Evid Based Complement Alternat Med. 2006;3:483-488. DOI
Verner-Jeffreys DW, Baker-Austin C, Pond MJ, et al. Zoonotic disease pathogens in fish used for pedicure. Emerg Infect Dis. 2012;18(6):1006-1008. DOI
This article is for general information; diagnosis and treatment are decided after examination.
Last updated: 24 October 2026 · Dr. Kağan Cingöz, MD, dermatologist
Contact
WhatsApp / Viber: +90 555 209 09 39 · info@drkagancingoz.com · İstasyon Mahallesi, Edirne Caddesi No:102, Kırklareli, Türkiye
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