How Fish Skin is Being Used to Treat Burn Victims

• Skin from cod and tilapia is being used to treat burns and other skin damage.
• Icelandic biotechnology company Kerecis has developed an FDA-approved cod-skin treatment that can speed up burn healing and reduce patient pain.
• The fish skin also prevents immune rejection and disease transfer, which are both issues involved with skin grafts from cadavers or animals such as pigs.

Bucking traditional treatments of cold compresses, doctors have started using an unexpected marine material to treat nasty burns: fish skin.

Their hope is that it will provide a cheaper and better treatment, as well as relieve pain.

While researchers around the world have been investigating how to use fish skin to treat burn victims, the question has been which species is best for the job, with some scientists using tilapia.

Now Kerecis, an Icelandic biotechnology company, thinks it has the answer. It is using skin from Atlantic cod for burn wounds, in the first FDA-approved form of this treatment.

Kerecis' Omega3 SurgiBind is grafted onto burned or otherwise damaged human skin, whereupon healthy human cells slowly grow across the fish skin, healing the wound beneath.

"The fish skin is used in the following manner: The doctor receives our fish-skin in sterile packaging. She inspects the wound and with a knife cuts away all dead tissue and makes the wound red and bleeding," Gudmundur Fertram Sigurjonsson, founder, president and CEO of Keracis, told Newsweek.

"The fish skin is then inserted into the wound and a wound dressing applied on top of the fish-skin. We only produce the fish skin—wound dressings from any vendor can be applied on top. The healthy cells from the wound perimeter will then crawl into the fish skin and over time convert it to human skin. The fish skin is never removed from the patient."

Kerecis produces fish skin grafts in the small fishing town of Isafjordur, Iceland, 20 miles south of the Arctic Circle. It uses by-products of the fishing industry that may otherwise go to waste. The fish skin is so versatile because it is strong, pliable, and tear-resistant, and only needs to be briefly rehydrated with saline before use.

Half a million people in the U.S. are burned in some way each year, leading to around 40,000 hospitalizations, according to the American Burn Association's National Burn Repository.

Burns are damage to the skin caused by heat or chemicals, and are defined by how many of the skin's layers are affected. The three layers of our skin include the outer epidermis, the dermis—which contains capillaries, nerve endings, sweat glands and hair follicles—and the deepest layer of tissue, the subcutis.

First-degree, or superficial burns, only affect the epidermis, while second-degree (partial thickness) burns affect the dermis too, according to Johns Hopkins Medicine. Third-degree burns, or full-thickness burns, reach all the way to the subcutis, and may even damage bones, muscles and tendons beneath them.

The use of the fish skin to treat burns decreased the wound's surface area, reduced patient pain, and shortened healing and recovery time, a pilot study of the technology at Atrium Health Pineville in 2019 found.

It can also be used for other forms of skin damage, including diabetic skin wounds and skin trauma.

On its website, Kerecis describes the story of one patient whose limb was saved by the fish-skin treatment. Chester Kitt, a 70-year-old fisherman from Seattle, developed a wound on his foot after a partial amputation that was struggling to heal due to his diabetes, to the point that there were fears that his entire foot would have to be amputated.

Kitt explains the struggles he faced trying to get his wound to heal, even having to crawl on his hands and knees to get around his house.

However, after only three weeks of Kerecis treatment, Kitt describes how his wound had entirely healed, allowing him to walk again, keep his foot, and regain his freedom.

Using the fish skin also reduces the chances of auto-immune reaction or disease transmission, according to a paper in the journal Military Medcine, which can often occur as a result of the application of cadaver and pig skin grafts.

This is because the fish cells are removed from the fish skin structure, including all the fish's DNA, meaning that the human body doesn't recognize the skin graft as a foreign body, happily colonizing the skin structure, a UN report says.

Diseases that can pass between other skin grafts from animals or cadaver donors, including mad cow disease or swine flu, cannot be transferred from the fish skin graft.

"Cod is a cold water fish and there is no viral disease transfer risk from cold water fish to humans because of the temperature difference between the cold water (34 degrees) and the human body (98.6 degrees), therefore the manufacturing and regulatory approvals for the cod-fish products are relatively straightforward (and no chemical waste stream from the factory)," Sigurjonsson said.

Other studies, including those by researchers at the Federal University of Ceará in Brazil, have shown that the skin of tilapia, a freshwater fish, is also an effective treatment for burns.

"Our preclinical studies have shown that tilapia skin is an excellent source of type I collagen," Maria Elisa Quezado Lima Verde, an associate professor in implant dentistry at Christus University Center in Brazil, and researcher into tilapia skin grafts, told Newsweek.

She said that it acts like a biological barrier, preventing dehydration, relieving pain, and avoiding the needs for dressing changes caused by gauze adhering to the skin. As a by-product, it is also cheaper than other treatments, she said.

However, according to Sigurjonsson, because tilapia are warm-water fish, they may be less suited to human skin grafting due to an increased risk of infection. This is due to viruses in the fish that may have adapted to temperatures similar to that of the human body, he said.

"Tilapia is experimental and not approved by regulatory bodies such as in Europe and the U.S. (FDA)," Sigurjonsson added.

Kerecis hopes to continue to develop its cod-skin graft for use in other medical issues, including hernia repair and breast reconstruction. It also hopes to use it in oral surgery, supporting tooth implants, and healing wounds.

"We feel that we are making a difference in patients lives every day—preventing amputations because of diabetic wounds, healing burn wounds and being an important material for surgeons in the operating room," Sigurjonsson said.

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