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Prof (Dr.) Atul Khajuria,
Tapaswi Ram Khajuria,
KIRAN KUMARI,
- DEAN, Faculty of Allied and Health Care Sciences Rayat Bahra Professional University VPO BOHAN, Tehsil & Distt. Hoshiarpur,, Punjab, India
- Retd. Lecturer, Education Dept. Govt. Higher Sec School Barola Udhampur, J&K, India
- Retd. Govt. Master, Education Dept. Govt. High School Pachote, Chenani, Udhampur, J&K, India
Abstract
Onychomycosis is a chronic fungal infection of the nail unit involving the plate, bed, and matrix, accounting for a substantial proportion of nail disorders encountered in dermatology practice worldwide. In South Asia—particularly India, Pakistan, Bangladesh, and Nepal—the burden is amplified by a convergence of climatic, socioeconomic, and healthcare-related factors. Hot and humid environmental conditions, widespread dermatophytosis, occlusive footwear practices, chronic wet work, and limited access to specialized mycological diagnostics contribute to increased prevalence, diagnostic uncertainty, and frequent therapeutic failure or relapse. Although population-based prevalence data remain limited, clinic-based studies consistently indicate that onychomycosis constitutes approximately 30–50% of nail diseases in tertiary care settings across the region. Epidemiologically, the infection predominantly affects adults in the economically productive age groups, with a higher prevalence among males, often linked to occupational exposure, trauma, and footwear habits. Toenail involvement is more common than fingernail disease and is frequently associated with concomitant tinea pedis or other dermatophytic infections, highlighting the role of nails as reservoirs of infection. The etiological spectrum in South Asia mirrors global patterns, with dermatophytes—especially Trichophyton rubrum—being the leading causative agents. However, emerging species such as T. mentagrophytes complex (including T. indotineae) and increasing isolation of non-dermatophyte moulds and Candida species reflect evolving mycological trends and raise concerns regarding antifungal resistance and treatment responsiveness. Risk factors in the region are multifactorial, encompassing environmental exposure, occupational hazards, lifestyle practices, and systemic comorbidities such as diabetes mellitus and peripheral vascular disease. Chronicity is reinforced by slow nail growth, biofilm formation, and reinfection from untreated skin reservoirs. Clinically, onychomycosis presents in varied morphological patterns, including distal lateral subungual, proximal subungual, superficial white, and total dystrophic forms, which often overlap and complicate diagnosis. Accurate diagnosis is essential to avoid unnecessary or ineffective treatment. However, in many South Asian settings, reliance on clinical diagnosis alone, empirical therapy, and misuse of topical steroid combinations are common. Laboratory confirmation through potassium hydroxide (KOH) microscopy, culture, and histopathology (PAS staining) remains the cornerstone, though accessibility and standardization remain challenges. Emerging diagnostic modalities such as dermoscopy and molecular techniques offer promise but are not yet widely available. Overall, onychomycosis in South Asia represents a significant yet under-recognized public health issue. Addressing it requires improved epidemiological surveillance, strengthened laboratory capacity, rational antifungal use, and context-specific management strategies that integrate clinical, microbiological, and socioeconomic considerations.
Keywords: Onychomycosis, Nail fungal infection ,Dermatophytes, Trichophyton rubrum, Trichophyton mentagrophytes complex, Trichophyton indotineae , Candida onychomycosis, Non-dermatophyte moulds (NDM)
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International Journal of Tropical Medicines
| Volume | 03 | |
| 02 | ||
| Received | 20/04/2026 | |
| Accepted | 05/06/2026 | |
| Published | 11/06/2026 | |
| Publication Time | 52 Days |