Lipner said the patient had no other medical history that she could link to her abnormal toenails. Fish pedicures involve a person placing their feet in a warm tub of water while having small fish nibble on them.
Writing in the journal JAMA Dermatology, she explained that the weird beauty ritual first gained traction after people noticed that wild populations of the toothless fish - a member of the carp family native to Turkey - liked to nibble on human skin, and for whatever reason, preferred munching on unsightly psoriasis plaques more than normal tissue.
Soon, sessions with the rebranded "doctor fish" were also being hailed as a treatment for improving eczema, rough skin, circulation, and cleanliness.
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"I think that this is probably more common than we think", said the report's author, Dr. Shari R. Lipner, an assistant professor of dermatology at Weill Cornell Medicine and director of the nail division. But this is the first case of onychomadesis tied to a fish pedicure, the new report said. However, people with onychomadesis usually experience spontaneous regrowth of their nail within 12 weeks, according to a 2017 report in the journal Cutis.
However, another expert disagrees, saying the woman's toenails could have fallen off because her toes were overlapping inside her shoes.
What she had done, though, was have a fish pedicure six months before. The most likely culprit, then, was the fish pedicure.
Lipner noticed that several of the woman's toenails had started separating from the nail beds.
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This might be safer but could also take longer, as new roads will need to be built to bring drilling equipment to different areas. Thailand is now in the midst of its monsoon season, and while Monday was relatively dry, the rains returned on Tuesday.
"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. There were reports of a patient with a Staphylococcus aureus infection after a fish pedicure.
Lipner would not reveal where the woman got the pedicure, but noted the treatment has been banned in at least 10 states, largely due to health concerns. Additionally, the fish are sometimes recycled from person to person, and a bacterial outbreak among the fish was reported in a 2011 investigation by the UK's Fish Health Inspectorate. As a result, people may see deep grooves that run horizontally across their nails - known as Beau lines - or they may see larger gaps where there is no nail, the AAD said.
Several spas in the USA and Canada offer fish pedicures but they are controversial.
Their use has been banned in some states in the U.S. - at least 10, by Lipner's count.
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