When a young U.S. woman began losing her toenails, her doctors were baffled. She had no medical problems, no problems with foot fungus, and no recent injuries to her toes.
But her dermatologist thinks she’s narrowed down on the culprit: a fish pedicure.
In a case report published Tuesday in the journal JAMA Dermatology, Dr. Shari Lipner from Weill Cornell Medicine describes the case of a patient in her 20s who arrived in her office saying she had been having problems with her toenails for the last six months.
Lipner noticed that several of the woman’s toenails had started separating from the nail beds. The woman said she had no history of any pain or trauma to her toes, no nail disorders or recent illnesses, and hadn’t started any new medications.
What she had done, though, was have a fish pedicure six months before.
In a fish pedicure, a client’s feet are immersed into tanks filled with small fish called Garra rufa or “doctor fish.” 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.
Several spas in the U.S. and Canada offer fish pedicures but they are controversial. Animal rights groups say the pedicures are a form of animal cruelty, while at least 10 U.S. states have banned fish pedicures over concerns about bacteria in the water.
Here in Canada, the Vancouver Island Health Authority shut down a fish pedicure spa in Duncan, B.C. in 2011, citing concerns the pedicures could lead to the transmission of skin diseases.
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.
“While the exact mechanism is unknown, it is likely that direct trauma caused by fish biting multiple nail units causes a cessation in nail plate production,” Lipner writes.
Lipner believes this is the first case linking a fish pedicure to onychomadesis, the technical term used to describe toenails falling off.
