Letter to JAMA-Dermatology

Thank you for helping correct the record, by considering submitting a letter to the JAMA-Dermatology Editor, below!

We invite you to write a letter to the Editor of JAMA-Dermatology and inform her of this problem. You may use the sample below, but please edit it as appropriate, so that the letter is your own, not ours. When you are finished composing your letter below, simply press the “send” button, and it will be e-mailed automatically to the JAMA-Dermatology office.

As you know, the article by Dr. Shari Lipner just published in JAMA-Dermmatology (Onychomadesis Following a Fish Pedicure. JAMA Dermatol. 2018;154(9):1091-1092) claims that a case of toe nail loss in a woman who was treated at a fish spa was caused by the Doctor Fish, Garra rufa, even though no evidence was presented that the fish was actually identified, and even though most fish spas in the U.S. do not actually use Garra rufa. This fact was brought to the attention of the Journal editor prior to print publication of the report, but the editor chose to publish the article without modification and without the submitted review describing this concern.

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Subject (For Example: Response to Lipner: Onychomadesis Following a Fish Pedicure. JAMA Dermatol. 2018;154(9):1091-1092 )

Your Message. Edit the suggested comments below in accordance with your style and conscience.
Dear Editor - I was pleased to see the article by Dr. Shari Lipner, entitled: Onychomadesis Following a Fish Pedicure. Adverse events from fish therapy and fish spas are so uncommon that case reports are one of the few ways that we get to learn about them. However, I take issue with the assumption that the fish that may have caused this reaction was Garra rufa (Family: Cyprinidae). While Garra rufa is the fish used therapeutically, fish spas in the U.S., Europe and Asia commonly use a very different fish, such as Talapia (Grassberger & Sherman. Ichthyotherapy. In: M. Grassberger et al, eds. Biotherapy - History, Principles and Practice. Dordrecht, The Netherlamds: Springer Science+Business Media; 2013:147-76). Talapia (Family: Cichlidae) are often passed off as Garra rufa because they are much more abundant and less expensive. Unlike Garra rufa, talapia have teeth, behave aggressively, and can cause bleeding or other trauma. Dr. Lipner suggested that Garra rufa was to blame, but provided no evidence that the fish at the fish spa was ever identified. It should be possible – and clearly it is crucial - to have the fish identified definitively by an ichthyologist. While that still will not prove whether or not the fish was to blame, at least it will inform us about which fish truly deserves our suspicion. Without solid evidence, Garra rufa should not be blamed for this illness. JAMA reviewers and editors should feel equally responsible for publishing this condemnation of Garra rufa without evidence that it was even at the scene of the crime.

Please also consider writing a comment on one or two webpages that have repeated this possibly erroneous claim. Press here to view a list of links to those websites.

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