Fish Pedicure Causes Woman to Lose Her Toenails

A young woman in New York developed a case of onychomadesis, a condition in which the nails stop growing and then completely fall off, after getting a fish pedicure at a spa. An assessment of this unusual case was recently published in JAMA Dermatology. 

The fish pedicure involves soaking the feet in warm water while Garra rufa, or “doctor fish” nibble away at dead skin. Fish pedicures have been clinically proven to help patients with psoriasis by significantly reducing psoriatic plaques while leaving healthy skin unaffected. In this case, however, it appears that the fish bit the nail units, thus causing the nail plate to stop growing. 

Although this is the first reported case of Garra rufa causing onychomadesis, health officials and doctors have always been wary about the commercial use of these fish from the Persian Gulf. According to the Centers for Disease Control and Prevention, the fish cannot be effectively cleaned between clients, and they can end up passing infections from customer to customer. These concerns have prompted over 10 states and some European countries to ban the fish from spas. In 2011, the British Fish Health Inspectorate investigated a shipment of Garra rufa from Indonesia and found a number of human pathogens that can cause invasive soft tissue infections. 

The unnamed woman’s dermatologist, Shari Lipner, MD, PhD, assured that her toenails will eventually grow back, but each nail could take up to 18 months to fully regrow.