"Pinecone disease" (commonly called "standing scales" or dropsy) in koi is generally divided into two types: localized scale protrusion and systemic (whole‑body) scale protrusion. The causes and severity differ between them.
I. Localized Scale Protrusion (Relatively Less Severe)
Characteristics: Scales stand up in a limited area of the body (e.g., near the dorsal or lateral line), usually without spreading.
Causes:
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Physical injury: Bacterial infection (e.g., Aeromonas hydrophila) after the fish scrapes or bumps itself.
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Local inflammation: Fluid builds up in the scale pockets due to tissue inflammation at the injury site, pushing the scales outward.
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Poor water quality: Deteriorating water conditions increase the risk of infection.
Features: Prognosis is better if treated promptly; delay can lead to systemic infection.
II. Systemic Scale Protrusion (More Serious)
Characteristics: Scales protrude symmetrically on both sides of the body, typically starting near the pectoral area and gradually spreading toward the abdomen and tail. The scales lift widely, giving a "pinecone" appearance.
Causes:
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Internal infection: Bacteria enter the body through the gills or intestines, causing infection in the chest or abdominal cavity.
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Edema/fluid accumulation: Inflammation of internal organs produces fluid that presses on the scale pockets, lifting the scales.
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Systemic septicemia: Bacteria enter the bloodstream, triggering a body‑wide inflammatory response.
Features: The condition progresses quickly, is difficult to treat, and has a high mortality rate. Immediate isolation and treatment are essential.

III. Other Possible Contributing Factors
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Factor
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Explanation
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|---|---|
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Sudden water‑quality change
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Stress from large temperature swings, improper water changes, high ammonia, etc.
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Weakened immunity
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Long‑term malnutrition, transport fatigue, unsuitable environment.
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Secondary infection
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Other diseases (e.g., gill rot, enteritis) not treated in time.
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IV. Key Distinguishing Points
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Type
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Affected Area
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Speed of Progression
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Severity
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|---|---|---|---|
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Localized
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One side, limited
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Relatively slow
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Less severe
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Systemic
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Both sides, symmetrical
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Faster
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Severe, life‑threatening
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Emergency Response Recommendations
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Isolate immediately: Prevent spread to other fish.
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Test water quality: Check pH, ammonia, nitrite.
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Treat appropriately: Localized cases may respond to external medicated baths; systemic cases require combined internal and external treatment.
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Consult a professional: Severe cases need expert diagnosis and medication.