Clinico-etiological Study of Nail Disorders at a Tertiary Care Center in Maharashtra, India

Abstract

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.