Lipner said the patient had no other medical history that she could link to her abnormal toenails.
Six months prior, the woman had dunked her feet in a tub of water filled with tiny fish called Garra rufa that will eat dead human skin when no plankton are around. The fish, which belong to the carp family and are native to the Middle East, normally eat plankton but will nibble on dead skin if no plankton is available.
A young woman lost her toenails when they began to separate from her toes.
"We don't see the [nail] shedding until months after the event, so I think it's hard for patients and physicians - especially if they're not even aware that fish pedicures can do this - to make that connection", she said. Dr. Lipner was convinced that her patient has no other previous health issues that would explain what happened with her toenails. Onychomadesis only temporarily stops nail growth, which usually resumes within 12 weeks, according to a 2017 study of the condition.
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"This is not uncommon in women with a Greek foot ... who wear high heels and pinpointed shoes", Tosti said, referring to feet whose second toes are longer than the first, like Greek statues.
As for the woman, her nails will likely return, but not for a long time.
"I do not recommend fish pedicures for any medical or aesthetic objective", she told Gizmodo. It's a typical byproduct of hand-foot-and-mouth disease, a viral infection common in children that appears as a rash on the hands and feet, so it's unclear how the infection was spread through the fish pedicure.
"This case highlights the importance of skin and nail problems associated with fish pedicures and the need for dermatologists to educate our patients about these adverse effects", the report concludes.
The report doesn't specify where the woman had her pedicure, for the sake of protecting her anonymity, but it's worth noting that the pedicures have been banned in many states in the USA, but they remain popular in China.
Lipner believes this is the first case linking a fish pedicure to onychomadesis, the technical term used to describe toenails falling off. They hit their peak in popularity in the USA around a decade ago, but have since been banned in at least 10 states, including NY, largely because of 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.
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