Earlier this year, a young woman from NY came to the dermatologists at Weill Cornell Medicine hospital because six of her toenails had begun detaching from her foot for no apparent reason six months prior. But the patient remembered having a fish pedicure "some months prior" to the start of her toenail woes.
Now a trendy beauty treatment, fish pedicures involve submersing feet into a tub of water filled with small fish known as "doctor fish". The species of fish used - a toothless carp known as Garra rufa - are usually plant eaters, but in a pinch, they will also eat dead human skin.
A photo showing onychomadesis on the first, second, and third toe of each of the patient's feet.
There have even been two recorded cases of serious staph infections tied to fish pedicures, Lipner noted.
It was quickly determined that the woman was suffering from onychomadesis, a condition in which the toe sheds nails after the nail matrix, the part of the nail bed beneath the nail that contains nerves, lymph and blood vessels, has been damaged.
"We will have to wait quite a while to see the outcome", she said. So, there's concern that the pedicures might spread infections.
Lipner, who is an assistant professor of dermatology at Columbia University's Weill Cornell Medicine, said this would be the first-ever documented case of the disease being caused by a fish pedicure.
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An image showing the woman's toenails disappearing.
It could take a year or longer for toenails to grow back. 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".
One skin expert not involved with the case said the report raises cause for concern. The culprit was found to be a streptococcal bacteria, a strain that is associated with fish like tilapia, according to David Verner-Jeffreys, a senior microbiologist at the Centre for Environment, Fisheries and Aquaculture Science in the UK. And healthy fish, he added, would mean "less problems all around".
The beauty craze has been banned in 10 U.S. states - including NY - because of health concerns.
Despite the name, "fish pedicures do not meet the legal definition of a pedicure", 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.
Lipner said in the JAMA report, "First, tubs and fish can not be adequately sanitized between people, and the same fish are typically reused for successive persons".