From The Editors Health

Woman Loses Toenails to Fish Pedicure

A woman in her twenties started losing her toenails to a nail-shredding disease called onychomadesis, which she is believed to have contracted after a Fish Pedicure six months earlier, suggests a doctor’s case report published in the journal JAMA Dermatology on Tuesday.

The controversial beauty treatment, also known as ichthyotherapy, involves immersing your feet in a tub of tepid water, filled with a freshwater fish species called “Garra rufa” happy to eat dead human-skin, if available, when its main food source, plankton, is hard to find.

Also known as “doctor fish,” this tiny species will nibble away at the dead skin around your toes and other parts of your feet, leaving behind unblemished rejuvenated skin, without any major issues; or so they believed until cases like this young lady’s started coming to light.

Medical professionals are just beginning to investigate the health repercussions of this new beauty indulgence that seems to be gaining popularity, what with celebrities like Kim Kardashian, knowingly or unknowingly, influencing fans and followers with video uploads of herself undergoing the fish treatment.

Symptoms of Onychomadesis usually start to appear long after the initial event that has caused it, which could be anything from a foot/toe injury to HFMD (hand, foot, mouth disease) among children and now, it appears, we can also include fish pedicure in that list.

Dr. Sheri Lipner – an assistant professor of dermatology at Weill Cornell Medicine and the author of the case report – attributed the young lady’s condition to fish traumatization to her toenails, saying that this could, potentially, be the first ever case of onychomadesis resulting from a fish pedicure.

Her conclusion is based on the fact that the woman didn’t have any other health issues that could, possibly, have caused her nails to fall off.

Hence, the only likely explanation for her disappearing toenails is Garra rufa traumatization to her nail matrix, although there isn’t any test that can confirm if, indeed, the toenail shedding was fish pedicure-induced.

“I think we’re fairly sure that it was the fish pedicure,” Dr. Sheri Lipner told Gizmodo

“While the mechanism of action is not entirely clear, it is likely due to the fish traumatizing the nail matrix,” she said.

Gizmodo also reported that in the interest of protecting the patient’s identity, Lipner declined to reveal where the woman got her fish pedicure.

Some experts are not convinced with the Garfa rufa-induced nail trauma theory, though.

One such person is Dr. Antonella Tosti, the Fredric Brandt Endowed Professor of Dermatology at the University Of Miami Miller School Of Medicine.

“I am not convinced at all that the fishes caused the problem,” he said.
He is of the opinion that that people with Greek feet, where the second toe is longer than the big toe, are more susceptible to losing toenails because of pointed shoes and high heels.

While either of the two likely explanations can’t be verified as of now, the fact remains that concerns have been raised about this line of pampering beauty treatment in the past as well, when a patient, reportedly, got infected with Staphylococcus aureus after getting a fish pedicure.

The case report published on the Springer Link website suggested that “fish pedicure can be a potentially dangerous procedure in immunocompromised or diabetic patients.”

It, basically, means that infections can be transferred from infected people to others via the “doctor fish” during a fish pedicure session. People with diabetes or dysfunctional immune systems are, particularly, vulnerable.

The patient was, however, successfully treated with the antibiotic, ciprofloxacin, with the study report stating that it was a one-off case of foot infection resulting from fish pedicure, at the time.

A U.K. Fish Health Inspectorate investigation reported a bacteria outbreak among spa fish, back in 2011.

Funded by the U.K. Department for Environment Food and Rural Affairs, the survey identified a total of 279 fish spas operating in the U.K, and there’s every chance that the number has increased substantially in the intervening years.

A letter entitled “Zoonotic Disease Pathogens in Fish Used for Pedicure,” published on the Centers for Disease Control and Prevention website, stated that “the Fish Health Inspectorate of the Centre for Environment, Fisheries & Aquaculture Science estimates that each week 15,000–20,000 G. rufa fish are imported from Indonesia and other countries in Asia into the United Kingdom through London Heathrow Airport (the main border inspection post for the import of live fish).”

The letter goes on to say that several U.S. States and Canadian Provinces have, reportedly, banned fish-pedicure, citing sanitary reasons.

“In the United Kingdom, a limited number of infections after fish pedicures have been reported,” the letter read.

The letter further pointed out that not much is known about “the types of bacteria and other potential pathogens that might be carried by these fish and the potential risks that they might pose to customers or to ornamental and native fish.’’

David Verner-Jeffreys – a senior microbiologist at the Centre for Environment, Fisheries and Aquaculture Science in the UK – held streptococcal bacteria responsible for the outbreak among the fish used in spas, saying that the fish spa trend in the country has gradually phased out.

“I wouldn’t say it necessarily poses a significant risk to humans, but it did illustrate that they may be carrying things which are nasty both to fish and humans. It was a bit of a craze people got excited about, and then they moved on to the next thing,” said the veteran microbiologist.

Coming back to our young lady with missing toenails, Lipner acknowledges that this is, perhaps, the first documented evidence of onychomadesis because of the fish pedicure.

“I do not recommend fish pedicures for any medical or aesthetic purpose,” Lipner said. “In addition to onychomadesis, there are also serious infections associated with fish pedicures.”

The woman’s toenails will ultimately make a come-back but it’s going to be a, rather, long wait before she can start beautifying her feet and toes again.
But you can bet your last buck she’s not going to walk into a fish spa, ever again.

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