A few months ago, a young woman went to her doctor in New York. Her toenails had gradually blackened over six months and fallen off. No one in her family had abnormal toenails and she had no diseases, no injuries, nor a family history of nail disorders. During the tests it was discovered that she had had a fish pedicure six months ago. The fish had caused injury to the nail matrix – the nail growth centre. This led to a nasty case of onychomadesis wherein the nail plates that make up the toenail halt production and separate, causing her nails to fall off. The condition can cause deep grooves to run horizontally across the nails, or large gaps where there is no nail. The case has been reported in JAMA Dermatology.
This is not the only problem fish pedicures have caused. They have also transmitted Staphylococcus aureus and mycobacteriosis infections. Staphylococcus aureus is a bacterium and a common cause of infections ranging from minor skin infections, such as pimples, boils, cellutitis, folliculitis, carbuncles, and abscesses, to life-threatening diseases such as pneumonia, meningitis, osteomyelitis, endocarditis, toxic shock syndrome, bacteremia and sepsis. An estimated 20 to 30 per cent of the human population are long-term carriers of S aureus. It can cause skin and soft-tissue infections, particularly when the skin has been breached. It can spread through contact with pus from an infected wound, skin-to-skin contact or contact with objects used by an infected person.
S aureus can lie dormant in the body for years. Once symptoms begin to show, if untreated, the disease can be deadly. Once the bacteria have entered the bloodstream, they can infect various organs. Without antibiotic treatment, S aureus bacteremia has a fatality rate around 80 per cent. With antibiotic treatment, case fatality rates range from 15 to 50 per cent depending on the age and health of the patient – but the bacterium is now almost antibiotic resistant.
Mycobacteriosis is a chronic disease that occurs in fish reared under intensive conditions. Temperatures between 25 ̊C and 35 ̊C are ideal for the bacteria.
In the last decade there has been a steady increase in the frequency of Mycobacterium marinum infections in cultured fish, and human cases associated with fish aquaria have been seen all over the world. In fish, transmission can occur by consumption of contaminated feed, aquatic detritus, or entry via injuries, skin abrasions or external parasites. In humans, breaks in the skin serve as an entry point for the organism through contaminated water sources, or infected fish and injury from fish fins or bites.
Mycobacteriosis infection most commonly manifests as a skin disease. Lesions tend to be noticed two to four weeks after exposure to the mycobacterium. The lesions swell and develop into ulcers which persist for months. In some instances, infection spreads to the lymph nodes. The skin, kidney and liver are the main parts affected in both fish and humans.
Diagnosis can be difficult and is often delayed, and by then the infection has spread, causing considerable damage to tendons and bone. Deep infections typically require both antibiotic and surgical treatment. Skin lesions can be chronic and leave scarring. Deep infections can lead to the loss of joint mobility, and severe cases may need amputation.
I have written about the dangers of fish pedicures before, but India still has parlours offering the service. I have just returned from Goa where the main tourist areas have small shady shacks advertising fish pedicures.
During a fish pedicure, people immerse their feet in a tub of water that contains small fish called Garra rufa. These fish supposedly pull out dead skin from the customer’s feet, exfoliating them as the customer relaxes and enjoys the tickle. These fish are especially grown in tanks and are imported into India.
These little fish are not doctors, cosmetologists or inanimate loofahs. They eat human flesh because they are starved of their normal diet of plankton or vegetable matter. The fish themselves are so mistreated by this unhealthy diet that outbreaks of systemic bacterial infections are common, causing abnormal eye protrusions and haemorrhaging around the gills, mouth and abdomen.
They carry bacteria responsible for a variety of dangerous tissue infections and the tubs in which you soak your feet are a fertile breeding ground and full of their excreta. Governments across the world have warned people that fish pedicures may even cause Hepatitis C and HIV.
Since they are not cosmetic surgeons, their biting results in bumpy uneven skin, and some areas are bitten deep enough to draw blood. Their nibbling of human feet could spread harmful microbes from one spa guest’s feet to the next. The hot water tub that you place your feet in is re-used, as are the fish and fungi, and disease-causing bacteria have been detected at fish pedicure spas. The mouths of the living fish cannot be cleaned or sterilised. The fish tanks are also not cleaned very often, or the water altered frequently enough. Obviously, all this increases the risk of spreading infection. These are the reasons that fish spas have been banned in many countries.
In 2011 and 2012, the Fish Health Directorate of Great Britain intercepted five different shipments of Garra rufa fish from Indonesia, bound for UK spas, and tested them for bacteria. They found that all the fish carried a number of harmful bacteria, including Aeromonas spp, Vibrio vulnificus, Vibrio cholerae and Streptococcus agalactiae, which can cause skin and soft-tissue infections. The strains were resistant to most antimicrobial medications, including tetracycline, gentamicin, neomycin and streptomycin. V vulnificus can cause wound infections and primary septicaemia, resulting in high mortality rates, especially among persons with liver disease, diabetes, or impaired immune function. S agalactiae is a common cause of skin and soft tissue infections, especially in older adults and those with chronic diseases such as diabetes mellitus.
The findings appear in Emerging Infectious Diseases, a journal published by the federal Centers for Disease Control and Prevention in Atlanta, which has been monitoring health effects associated with fish pedicures. In 2014, researchers from Italy reported cases of customers developing foot infections caused by the Staphylococcus aureus bacterium. Since then infections have been reported in Great Britain, according to the Health Protection Agency.
In the absence of any regulation in India, shady shops have sprung up online which sell garra rufa fish. No one knows how they have been able to import them. I saw an ad of a Mumbai shop, Pedifish, which sells “fish spa” fish at Rs 8, and Rs 40 for grarra rufa hybrids. They take orders of a minimum of 1000 “pieces” – which shows you how little they know, or care, about fish.
If you want to clean your feet use a pumice stone not a live fish.