Lipner said the patient had no other medical history that she could link to her abnormal toenails.
That's because we know that fish pedicures pose a risk of transmitting infections, as the fish are often used on more than one customer. The dermatologist said it was most likely linked to the fish pedicure.
Though it does not meet the legal definition of a pedicure, the practice of sticking your feet into a tub filled with diminutive omnivorous fish from the species Garra rufa has been a popular spa service worldwide for more than a decade, according to Dr Lipner.
"First, tubs and fish can not be adequately sanitized between people", Lipner said, "with the same fish typically reused for several persons".
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Fish spas used to be all the rage when they first came out.
While Lipner believes that the woman's problems stemmed from the physical impact of the fish biting at the nail, she noted that there have been past reports of infections associated with fish pedicures, too. "Therefore, we will have to wait quite a while to see the outcome", she said.
If you are on holiday and you just can't resist the ticklish temptation, then do your research into your chosen treatment facility and ensure they are reputable and clean. Toenails only grow one millimeter a month on average, while an entire nail can take as long as 18 months to be replaced. In work done previously with the UK's Health Protection Agency, she helped produce the agency's 2011 guidance on fish spas.
Fish tubs (and the fish inside) can't be properly sanitized, and after feeding on multiple feet, the fish have been known to transmit infections, such as Staphylococcus aureus and Mycobacterium marinum.
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One skin expert not involved with the case said the report raises cause for concern. These fish will eat dead human skin when no plankton are around, so they leave your feet feeling soft and smooth.
Despite the name, "fish pedicures do not meet the legal definition of a pedicure", the CDC says.
"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".
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".
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