A Cross-sectional Study of the Clinical and Mycological Profile of Onychomycosis in a Tertiary Care Center

Background: Onychomycosis is a chronic fungal infection of the nail apparatus caused by dermatophytes, Non-dermatophyte molds (NDMs), and yeasts, with rising incidence in tropical regions. Despite its high prevalence and impact on quality of life, regional data on its clinical and mycological profile remain limited. Objective: The objective of this study was to assess the clinicoepidemiological and mycological characteristics of onychomycosis among patients attending a tertiary care hospital in Eastern Nepal. Materials and Methods: This hospital-based cross-sectional study included 116 patients with clinically suspected onychomycosis. Detailed history, nail examination, and potassium hydroxide (KOH) wet mount, along with fungal cultures, were performed on nail clippings. Isolates were identified using standard microbiological techniques. Data were analyzed using SPSS v26. Results: Most patients were males (56.9%), with the highest prevalence in the 31–40 years age group (23.3%). The most common symptoms were nail discoloration (96.6%) and subungual hyperkeratosis (76.7%). Frequent exposure to water/soil (34.5%) was a major predisposing factor, especially among females ( P < 0.001). Dermatophytoses (37.6%) were the most common etiology, predominantly Trichophyton rubrum . NDMs accounted for 32.8% of isolates – mainly Aspergillus , Cladosporium , and Scopulariopsis species – while yeasts constituted 5.6%. Fungal culture positivity (76%) surpassed KOH mount positivity (48%), emphasizing the importance of combined diagnostic methods. Conclusion: Onychomycosis affects adults in their productive years and is associated with varied occupational and environmental risk factors. Dermatophytes remain the leading pathogens; however, NDMs are emerging as significant causative agents. Accurate mycological diagnosis is critical for effective management and antifungal stewardship in resource-limited, tropical settings.