During a fish pedicure, people immerse their feet in warm water and let doctor fish eat away at dead skin.
A photo showing onychomadesis on the first, second, and third toe of each of the patient's feet.
Fish pedicures may be a fun way to exfoliate rough heels, but experts are now warning that the procedure may pose an infection risk.
Lipner said the patient had no other medical history that she could link to her abnormal toenails. The condition occurs when something causes the nails to stop growing for a while, according to the American Academy of Dermatology (AAD).
That raises the odds for infections transmitted between customers, and "several bacteria capable of causing disease in humans were isolated in batches of Garra rufa and waters from 24 fish spas", she said. While experts still don't know exactly how fish pedicure-borne infections happen, it could be due to lingering bacteria from the last person to put their food it in the fish tank.
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The woman's toenails will return, but not for a long time, said Lipner.
According to Lipner, this would be the first documented instance of onychomadesis ever caused by fish.
A few case reports have also directly traced foot infections to these treatments. In fact, the United Kingdom government's Health Protection Agency (HPA) published a report on fish pedicure safety in 2011 and concluded that the risk for infection from the treatment is "likely to be very low". But there were special contraindications for fish pedicures that needed to be considered; recent waxing or shaving, certain skin disorders and cuts on the feet or legs could increase one's risk of infection, she said. And healthy fish, he added, would mean "less problems all around". According to the CDC, more than 10 US states have banned fish pedicures entirely. In addition, the fish themselves can not be sanitized between each customer's pedicure session, the CDC says.
While Garra rufa have been investigated as a treatment for psoriasis - though not in the context of a nail salon - Lipner stressed that this is not standard medical practice.
"I think we can pretty definitively say that getting a fish pedicure is probably not the way to go to treat skin and nail conditions".
In the JAMA case, Lipner says with no other explanation for what could have caused the problems with the young woman's toenails, the pedicure seems the most likely culprit.