Ruling those causes out, "to my knowledge this is the first case of onychomadesis associated with a fish pedicure", she said. You put your feet in a tub of water filled with tiny fish who eat your dead skin.
According to a new report in the journal JAMA Dermatology, the patient had received such a treatment and noticed later that her toenails began shedding. Dr. Lipner was convinced that her patient has no other previous health issues that would explain what happened with her toenails.
That's because we know that fish pedicures pose a risk of transmitting infections, as the fish are often used on more than one customer.
Writing in the journal JAMA Dermatology, she explained that the freaky beauty ritual first gained traction after people noticed that wild populations of the toothless fish - a member of the carp family native to Turkey - liked to nibble on human skin, and for whatever reason, preferred munching on unsightly psoriasis plaques more than normal tissue.
"Being omnivores", the fish "will eat human skin", wrote case report author Dr. Shari Lipner, a dermatologist at Weill Cornell Medicine in New York City. This nail shedding is called onychomadesis, and it usually results in the nail falling off after an injury stops nail growth.
Lipner said the patient had no other medical history that she could link to her abnormal toenails.
"I do not recommend fish pedicures for any medical or aesthetic objective", she told Gizmodo.
The case, as far as Lipner knows, would be the first documented instance of onychomadesis ever caused by fish.
Another species of fish, which "grows teeth and can draw blood", is sometimes mistaken for Garra rufa and used in fish pedicures, according to the US Centers for Disease Control and Prevention. In addition, in 2014, researchers from Italy reported the case of a person who took a fish pedicure and then developed a foot infection caused by the Staphylococcus aureus bacterium. Lipner was not able to identify the fish species involved in this case.
Lipner would not reveal where the woman got the pedicure, but noted the treatment has been banned in at least 10 states, largely due to health concerns. 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.
"We will have to wait quite a while to see the outcome", she said.
At least 10 states in the USA have banned the treatment because of its potential health hazards, the CDC said, though 2011 Health Protection Agency guidelines considered the risk of bacterial infection from fish spas to be "very low" but not completely avoidable.
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