A Systematic Review of the Efficacy and Histopathological Outcomes of Tilapia Fish Skin as a Biological Dressing for Acute Thermal Burns

Abstract

Background: Burn injuries remain a major global health concern, contributing significantly to morbidity, mortality, and healthcare costs, particularly in low- and middle-income countries. The quest for an ideal wound dressing that accelerates healing, minimizes infection, reduces pain, and restores skin integrity with minimal scarring has prompted the exploration of biological dressings. Recently, Tilapia fish skin (TFS) has emerged as a promising xenograft material due to its collagen-rich composition, biocompatibility, and structural similarity to human skin. Objective: This systematic review aims to evaluate the efficacy and histopathological outcomes of Tilapia fish skin as a biological dressing for acute thermal burns, comparing its performance with conventional and other biological dressings. Methods: A systematic search was conducted in PubMed, Scopus, Web of Science, and Cochrane Library databases for studies published between 2015 and 2025. Eligible studies included randomized controlled trials, cohort studies, and experimental animal models assessing TFS in acute thermal burns. Data extraction focused on wound healing time, pain scores, infection rates, histopathological changes, collagen deposition, epithelialization, and patient satisfaction. The risk of bias was assessed using the Cochrane Risk of Bias Tool and SYRCLE’s tool for animal studies. Results: Twelve  studies met the inclusion criteria, encompassing both clinical and preclinical evidence. Most clinical trials demonstrated that TFS significantly reduced healing time (by 3–5 days on average) and decreased pain intensity compared with silver sulfadiazine or hydrocolloid dressings. Infection control outcomes were comparable or superior to conventional methods due to the natural antimicrobial peptides in TFS. Histopathological analyses across studies revealed enhanced neovascularization, denser collagen type I and III deposition, and earlier re-epithelialization in TFS-treated wounds. Furthermore, patients reported better comfort, fewer dressing changes, and improved cosmetic outcomes. In animal models, TFS promoted faster granulation tissue formation and reduced inflammatory cell infiltration compared to controls. Conclusion:

Tilapia fish skin appears to be an effective and biologically safe alternative dressing for acute thermal burns, offering accelerated healing, reduced pain, and favorable histopathological outcomes. Its low cost, wide availability, and ease of sterilization make it a viable solution, especially in resource-limited settings.