The clinical efficacy of becaplermin (Regranex®, Ortho-McNeil Pharmaceutical, Inc., Raritan, New Jersey 08869) on head and lateral line erosion syndrome (HLLES) in ocean surgeonfish (Acanthurus bahianus) was examined in a two-part study to determine suitable application frequencies of the drug and the effects of the environment on outcome of treatments. In the first part of the study, 12 ocean surgeonfish with prior HLLES were equally divided into three treatment groups, varying in application frequency of becaplermin: 1) one application, 2) three applications every 3 wk, and 3) no applications. After 9 wk, it was determined through photograph and computer analysis that fish treated with becaplermin did heal significantly more than the fish that were not treated. No significant difference was found when comparing the two treatment regimes; therefore, a one-time treatment of becaplermin was just as effective as the three-time application, reducing cost of the treatment, staff labor, and stress to the animals. In the second part of the study, the effect of the water environment on HLLES development was documented before and after a one-time treatment of becaplermin. When fish were treated and placed into a system known to cause HLLES, the becaplermin treatment had no effect on reducing the HLLES progression, whereas treated fish that were placed into a system that did not cause HLLES showed a significant decrease in erosion after the treatment. Therefore, treating fish being placed into a HLLES-causing system serves no beneficial purpose to healing HLLES.