Onychomycosis prevalence etiology and associated factors in women using nail cosmetics attending Mbarara regional referral hospital dermatology clinic Uganda

Abstract

Onychomycosis is a fungal infection of the nails caused primarily by dermatophytes, Non-Dermatophyte Moulds (NDMs) and yeast species. Fungal transmission occurs through direct contact with contaminated objects. Nail cosmetic treatments involve using tools that may be contaminated with fungus and can traumatize the nail, potentially increasing the risk of infection. However, little is known about its prevalence, etiology and associated factors among women using nail cosmetics in Uganda. A cross-sectional study at Mbarara Regional Referral Hospital (MRRH) skin clinic (January March 2025) enrolled 273 women with a history of nail cosmetic use. Nail clippings of participants underwent direct microscopy and fungal culture to assess the prevalence and etiology. Fungal isolates were identified morphologically using lactophenol cotton blue staining. Data collected using a structured questionnaire were analyzed in STATA 12.0. Univariate and multivariate logistic regression identified associated factors; adjusted odds ratios (ORs), 95% confidence intervals (CIs), and p-values were calculated using Wald’s test (p < 0.05 significant). The prevalence of onychomycosis among women using nail cosmetic was 57.5%. Dermatophytes were the most frequently isolated organisms, with Trichophyton mentagrophytes being predominant, followed by NDMs and Candida species. Frequent nail polish application, nail trauma and sales/retail occupations showed a statistically significant association with onychomycosis (p < 0.05). Onychomycosis was prevalent among women using nail cosmetics, with predominance of Trichophyton mentagrophytes. And associated with nail trauma, frequent application, and sales/retail occupation. These associations suggest that trauma and frequent application may elevate infection risk, while henna offers potential protection with antifungal properties. These findings highlight the need for public awareness and improved hygiene standards in nail care practices.