clinico-etiological study of nail disorders at a tertiary care center in maharashtra, india

Background: nail abnormalities comprise a significant proportion of dermatological disorders. nail is a window that provides vital clues for any underlying, dermatological, and systemic diseases. any cutaneous assessment is incomplete without examining nails despite which it is a fairly neglected appendage. objectives: this study was carried out to document the clinical pattern, determine the etiology, and identify risk factors for various nail changes. methods: this cross-sectional observational study was conducted on 200 consecutive patients presenting with nail changes to the outpatient department of dermatology and venereal diseases of a tertiary care hospital. the patients were enrolled after obtaining informed consent. a case record form was designed for every patient, including demographic data, nail characteristics, associated dermatological and systemic disease, and investigation details. results: the mean age of the patients was 37.98 ± 16.79 years with a male preponderance. occupation (housewife and manual laborer) was observed to be a significant risk factor (p < 0.001) for onychomycosis. the chief complaint related to nails was cosmetic in 49.5% of the cases. etiology-wise nail changes secondary to dermatological diseases (44%) were the most common, followed by infections (36%); however, among dermatological diseases, psoriasis (42.2%) followed by lichen planus (16.6%) predominated. although nail pitting was noticed in various conditions, there was a significant association between nail pitting and psoriasis (p < 0.001). onychomycosis showed a significant association (p < 0.001) with nail discoloration and onycholysis. distal lateral subungual onychomycosis (61.4%) was the most frequently observed pattern; nevertheless, the most common causative agent was dermatophyte trichophyton rubrum (58.26%). a nail biopsy was performed on 15 cases, with conclusive findings in 12 patients. conclusions: nails should be considered an integral part of the complete dermatological evaluation. the meticulous examination of nails facilitates the early diagnosis of hitherto undetected cutaneous/systemic disease. the nail unit deserves greater attention for better understanding and utilization as a diagnostic tool.