In a fish pedicure, a client's feet are immersed into tanks filled with small fish called Garra rufa or "doctor fish". According to Gizmodo, Lipner can't reveal where the woman got her pedicure in order to protect the patient's identity, but she said the patient has no other medical history that would cause her nail shedding. Dermatologist and lead author Shari Lipner diagnosed the woman with onychomadesis, or a condition that halts nail growth at its root, likely caused by fish repeatedly biting the affected toes during the treatment.
However, another expert disagrees, saying the woman's toenails could have fallen off because her toes were overlapping inside her shoes.
However, routine use of the fish for pedicures is another matter, she said, and may often cause more harm than good. Ruling those causes out, "to my knowledge this is the first case of onychomadesis associated with a fish pedicure", she said. However, people with onychomadesis usually experience spontaneous regrowth of their nail within 12 weeks, according to a 2017 report in the journal Cutis. These fish will eat dead human skin when no plankton are around, so they leave your feet feeling soft and smooth.
"While the mechanism of action is not entirely clear, it is likely due to the fish traumatizing the nail matrix", Sheri Lipner, an assistant professor of dermatology at Columbia University's Weill Cornell Medicine and the woman's doctor, told the website. Although there's no definitive test for fish-nibble-induced toenail loss, "I think we're fairly sure that it was the fish pedicure", she said.
Lipner said the woman's nails may grow back - but it'll take as long as 18 months.
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What she had done, though, was have a fish pedicure six months before. In addition, the fish themselves can not be sanitized between each customer's pedicure session, the CDC says.
One skin expert not involved with the case said the report raises cause for concern. And though proponents of fish pedicures have argued they can properly sanitise the fish and tubs between uses, research has shown that disease-causing bacteria can be readily found in both the tubs and fish used in these spas.
Their use has been banned in some states in the U.S. - at least 10, by Lipner's count.
In 2011, an investigation by the UK's Fish Health Inspectorate found a bacterial outbreak among thousands of these fish, which had been transported from Indonesia to United Kingdom pedicure spas. Spas can also mistake the toothy chinchin fish, which draws blood, for the doctor fish, further increasing the risk of infection, the Centers for Disease Control and Prevention said.
"We will have to wait quite a while to see the outcome", she said.