Introduction: Nails are specialized structures reflecting systemic health and nail disorders may indicate trauma, infections, dermatological conditions or systemic illnesses. Onychoscopy, a non-invasive diagnostic technique, allows detailed visualization of the nail unit, aiding early diagnosis and reducing reliance on invasive procedures. Aim: To evaluate the dermoscopic (onychoscopic) features of various nail disorders and assess their diagnostic utility. Materials and Methods: This hospital-based, cross-sectional observational study was conducted at the Department of Dermatology, Venereology and Leprology, Sawai Man Singh Medical College, Jaipur, from November 2023 to October 2024. A total of 120 patients with clinically diagnosed nail disorders were enrolled. Detailed demographic, clinical and laboratory data were collected. Onychoscopic examination was performed using a handheld dermoscope (10× magnification, polarized and non-polarized modes). Findings were recorded and analyzed using SPSS version 20; p < 0.05 was considered significant. Results: Patients were aged 4–80 years (mean 37 ± 14.75 years), with male predominance (59.17%). Housewives (35%) and students (24.17%) were most commonly affected. Onychomycosis (45%), nail psoriasis (25.83%) and nail lichen planus (8.33%) were the most frequent disorders. Common onychoscopic findings included chromonychia (83.33%), spike patterns (75.9%), distal irregular termination (70.37%), subungual hyperkeratosis (64.81%) and leukonychia (66.66%). Condition-specific features such as pterygium, nail pitting, tortuous capillaries, and pseudo-Hutchinson sign were useful in differentiating disorders. Rare conditions like onychopapilloma, melanonychia and pityriasis rubra pilaris showed distinctive patterns. Fingernails were more frequently involved than toenails. Conclusion:Onychoscopy is a valuable, non-invasive diagnostic tool for evaluating nail disorders, enabling identification of characteristic patterns and aiding differentiation of common and rare conditions. Its routine use can enhance diagnostic accuracy and guide appropriate management.
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