Fish skin may be the safest and most effective way of treating severe burns. Exposing burns to the skin of Atlantic cod seems to result in patients spending less time in hospital and experiencing fewer complications compared with other treatments. This may be due to cod skin containing omega-3 fatty acids that trigger just the right amount of inflammation to assist the healing process.聽
鈥淔ish skin actually looks a lot like human skin when you look at it with a microscope, so maybe it works like [our] skin,鈥� says聽聽at the Icahn School of Medicine at Mount Sinai, New York. 鈥淸It] offers a faster, possibly slightly cleaner way of rebuilding your skin than some other options.鈥�
Every day, more than聽聽that聽require medical attention. Severe cases are often treated with grafts, where healthy skin is taken from one part of the body and moved to cover or replace skin that is damaged or missing.聽
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Prior to graft surgery, many patients undergo temporary wound coverage to prepare the area and manage infection risk. This can involve applying synthetic or biosynthetic scaffolds made up of collagen, the most abundant protein in skin. But an Icelandic company called Kerecis manufactures聽products made from wild Atlantic cod (Gadus morhua), which are approved to treat burns and other wounds in the US and the UK.聽
To compare these approaches, Lantis and his colleagues used data from 465 adults who attended 49 burn centres between 2019 and 2025.聽
All the adults had moderately sized burns affecting 13 per cent of their body, on average. Most of the burns were either mixed 鈥� affecting multiple layers of the skin 鈥� or third-degree, in which the outer and middle layers of the skin are destroyed, with no sensation in the area. The underlying bones, muscles and tendons are sometimes also affected.
Prior to undergoing a skin graft, 93 of these patients were treated with聽GraftGuide, a minimally processed intact fish skin from Kerecis,聽which funded the study but didn鈥檛 analyse the data. The remaining patients received approved synthetic substitutes. The two groups were matched for factors like age, sex, burn severity and size, and any other complications from the injury.
The researchers found that the individuals treated with GraftGuide spent 12 fewer days in hospital, on average, than those who got synthetic substitutes, with the former group being discharged after an average of 23 days and the latter after an average of 35.
What鈥檚 more, rates of complications were twice as high in the synthetic-substitute group, with 16 per cent experiencing issues like sepsis, compared with 8 per cent who received GraftGuide.聽
Atlantic cod naturally contains collagen and omega-3 fatty acids. Unpublished data suggests that putting omega-3 on burns causes an initial spike in inflammation, which helps stop any bleeding, says Lantis. This inflammation then quickly fades, assisting healing, he says. 鈥淚f you had a wish list, you鈥檇 say, we want a lot of inflammation [initially], but you don鈥檛 want to keep inflammation going.鈥�
Very few fish viruses are thought to affect people, which means the skin doesn鈥檛 have to be treated with harsh detergents that could wash away the omega-3, says Lantis. An advantage of Atlantic cod over other fishes is that it has a relatively large body size, so you can get a lot of skin from each fish, he says.
Comparing equivalent patients who received different treatments is always difficult, says聽聽at the University of Western Australia. Formal head-to-head trials directly comparing the approaches are needed, she says.聽
One such聽聽is assessing whether Kerecis鈥檚 fish-skin product reduces the need for grafts in second-degree burns, which affect just the outer and middle layers of the skin. Each participant will receive fish skin to part of their burn, while the rest of it will be treated with a graft. 鈥淓very patient鈥檚 their own control,鈥� says Lantis. This should eliminate the risk of discrepancies between participants affecting the results, he says.聽
medRxiv
