The study was conducted as an expert interview. The research tool was a categorized interview questionnaire using the CAWI (Computer Assisted Web Interview) technique. The research period covered the period from 13 August 2020 to 21 June 2021. The anonymous interview questionnaire consisted of a set of 11 questions, the last of which was an additional question and concerned the description of the case study. The questionnaire was sent by e-mail to ten experts from Poland, and three of them replied.

The group of subjects was selected using a non-probabilistic schema by targeted selection. They were experts, i.e., competent people with theoretical knowledge and practical skills gained during numerous courses and trainings. One of the study participants is a member of the British Association of Hirudotherapy. They have at least 5 years of experience in carrying out hirudotherapy treatments.

2.1. Hirudotherapy Use—Questionnaire for Experts

We asked about the motivation that led therapists to become interested in hirudotherapy. The career path began with the following points: as a transition from professional leech breeding to therapy, as a result of contact with hirudotherapy carried out in a family member, and the interest in the subject itself. In the following years, the respondents underwent numerous trainings and apprenticeships, and took part in courses and symposia, which very often took place abroad, e.g., in Russia, England and Ukraine. One of the experts admits: “Without specialized education, it is difficult to expect greater success in hirudotherapy”.

The respondents agree as regards the perception of hirudotherapy by the external environment: “People’s reactions are extreme, it doesn’t matter whether we are talking about people with medical education or not.”. People who have had direct or indirect contact with this therapy in the past have a clearly positive attitude. There are people, including medical doctors, who describe this therapy as “bloodletting superstition”, “black magic” or “charlatanism and the Middle Ages”. It has been observed that the majority of women have a neutral to negative attitude to leeches, considering them disgusting, but usually the attitude changes to a positive one after 2–3 treatments. Men show a negative attitude more often than women. Nevertheless, interviewed experts promote hirudotherapy: “Leeches are an officially recognized therapeutic agent. I repeat this to my patients and medical doctors I know.”. One expert notes that, over the last 10 years, the overall opinion about leeches has changed to a more positive one: “It is more and more common that medical doctors send some of their patients to me”. Nowadays, hirudotherapy is still controversial, and the potential reasons for them are anxiety about the origin of leeches, as well as about the side effects, such as severe bleeding or allergic reactions. Discussion, especially among animal lovers, centers around the fact that leeches are used as “disposable needles” and are then put to sleep after a single treatment. Another respondent believes that the lack of legal regulations and supervision is controversial, as they lead to this therapy being conducted by incompetent people who do not have adequate preparation: “Contrary to popular opinion, leeches can be harmful. Working with human blood also requires responsibility and compliance with appropriate epidemiological procedures. I often come across the use of sanitary pads or cotton pads in dressings, which is unacceptable. During the symposium of hirudotherapists and hirudologists in Georgia, I conducted a survey, which shows that a large number of people do not use gloves during the procedure, even when applying a dressing, it puts the whole group of people dealing with hirudotherapy in a very bad light. There is also a big problem with proper preparation of the patient and explaining what to do after the procedure. A patient with a poorly made dressing that leaks quickly is left to fend for her/himself. Lack of proper preparation and care results in calling the Medical Rescue Team. Medical rescuers, seeing unprofessional dressings, mock hirudotherapy. Lack of adequate education and awareness of the risk of complications after the procedure means that the therapist does not know what to do with the patient when he has a problem. The patient goes to the medical doctor who, having no extensive knowledge about the treatment with use of leeches, introduces prophylactic antibiotic therapy.”.

The conducted study clearly indicates that the greatest increases in interest in hirudotherapy are caused by information in the media, both positive and negative: “The greatest increases are always seen after articles in the press, both positive and negative. People learn more about the method and sign up for the procedure. We had the biggest jump after the scandal in May 2008 involving Dr. Lenart (Polish orthopedic surgeon using leeches in a patient at risk of leg amputation, brought before a medical ethics committee).”. Although mentions of hirudotherapy can multiply the number of patients, the effect is transient: “A newspaper article or television program can double the number of people interested—for a few days, of course.”. Spoken word is also effective promotion: “Patients become interested if they hear about it on TV or know someone who has tried therapy.”.

Experts agree that clients usually choose this method due to the ineffectiveness of other methods, including pharmaceutical therapies, medical advice and surgery. They often refer to hirudotherapy as the “last resort”. Some people benefit from leech therapy because “they believe in alternative medicine and don’t want to use drugs, steroids, botox and hyaluronic acid”.

In response to the question, “What dermatoses or cosmetological ailments are the most common among the customers?”, the following dermatoses are given:

In the opinion of experts, the most common contraindications in people seeking hirudotherapy in Poland are:

abnormalities in blood counts, anemia;

use of anticoagulants;

severe infections and severe allergies.

In the opinion of the surveyed experts, the post-treatment recommendations that cause the most difficulties to clients are:

no scratching and touching the post-treatment area;

changing the dressing on the hard-to-reach areas (e.g., on the back).

Some customers complain about the ban on soaking wounds because they cannot take a bath or go to the swimming pool. One of the experts replied that the recommendations after the procedure are not difficult to follow, but the clients do not stick to the rules and do not accept the fact that the day after the procedure they should rest, limit their physical activity, not scratch or soak the wound, wear clothes that will provide airflow around the dressing and refrain from drinking alcohol, as it worsens the bleeding. The expert also adds that before the procedure, the patient is informed in detail, fills in the patient’s card and signs consent forms.

Among the most common side effects, respondents indicate: reddening of the skin, swelling, inflammation, and itching, although their occurrence depends on the patient’s body and health condition, e.g., “smokers may experience much stronger reactions to a leech bite”. None of the respondents stated the exacerbation of dermatological complaints, although there was mention of a one-off increase in back pain after the procedure.

2.2. Use of Hirudotherapy in a Cosmetic Salon

In the opinion of the experts, hirudotherapy provides the best results in the treatment of rosacea and various local inflammations, and one of the respondents stated high effectiveness in bruises, lipomas, skin scars and difficult-to-heal wounds. In the case of other dermatoses, all indicated that the treatment was more complicated, its duration had to be extended and the effectiveness was slightly lower.

Another question, regarding the popularity of using hirudotherapy in combating dermatoses or cosmetic ailments, and the possibility of having this therapy compete with other treatments performed in cosmetology salons, presented various answers. The first of the respondents declares that people undergoing treatment of dermatoses with leeches constitute about 5% of his patients. This expert also emphasized the importance of diet as the basis for therapy. Both the first and the second respondents recommend a leech blood-lifting mask to effectively and non-invasively reduce fine wrinkles, brighten the skin and smooth it. In their opinion, the effect is comparable to the effects of widely used cosmetic treatments that exfoliate the skin. However, the disadvantage of the mask is the risk of leaving traces on the skin after a bite of leeches, and the sight of a large amount of blood can also be problematic for the person subjected to the treatment. The last respondent believes that, when the knowledge about hirudotherapy and the healing properties of enzymes derived from leech saliva is disseminated, and when the visual effect of the treatments is noted, then hirudotherapy has a chance to compete with other methods. The effect of therapy with leeches is expected to be longer than the effect of treatments performed in a cosmetology salon; however, these methods, although faster, are also more invasive.

As opportunities to increase interest in hirudotherapy in cosmetology, experts pay attention to media promotion, awareness-raising and education, and one of the experts recommends exhibitions with visual evidence of the effectiveness of the therapy. An important element is also the aforementioned lifting mask, which is rated much higher than other masks in a beauty salon; this has the potential to make hirudotherapy a field of competition with other cosmetology salons.

As barriers and threats to the development of hirudotherapy and its application in cosmetology, experts indicated the essence of a professional approach, having appropriate qualifications and competences: “With inexperienced and poorly qualified personnel, post-treatment problems will appear more often”. The feeling of discomfort caused by leeches applied to the face area, post-treatment bleeding and extended waiting time for the effect may be factors that constitute a barrier to the use of hirudotherapy in cosmetology.

2.3. Cases Description

The last question in the questionnaire was an additional element. It was addressed to experts in the form of a request for a description of a selected case undergoing leech therapy for the treatment of skin lesions.

First case: a 42-year-old woman suffered from psoriasis and psychiatric disorders for 7 years. The factors accompanying and triggering skin manifestations were stress and improper diet. Psoriatic lesions covered the entire body, including the scalp. Before the patient was admitted to the hirudotherapy office, she had 10 days of radiation therapy in the hospital. The condition of the skin after treatment hospital is shown in Figure 2.The therapy with leeches consisted of six sessions and a change of leeches was applied once a week: first week—5 leeches near the liver; and the second week—6 leeches near the kidneys (3 on each side). The therapy ended with an improvement in the condition of the skin (Figure 3).

Unfortunately, the patient returned to her old eating habits (including sweets, milk, pastries). Despite the recommended re-therapy with leeches after six months, the client did not follow the recommendation. After one year, the disease recurred.

Second case report: a 38-year-old woman suffering from varicose veins visible on the inside of her left leg, accompanied by pain. Hirudotherapy lasted 5 months. A max. of 3 to 4 leeches were placed every 4–6 days around the navel and around the areas affected by varicose veins. Pain and itching were reduced and the visual effect of the therapy can be seen in Figure 4.