Introduction Anatomically, nail is a hard protective covering over the terminal phalynx, and this helps to avoid any injury, as well as enhances the sensory perception over the pulp of digits. The nail apparatus consists of nail plate, nail folds, nail bed, and hyponychium. Various Diseases may affect the nail, eg infections, papulosquamous disorder, habitual dosrde and tumorers. Patients and methods We included 250 patients aged more than 18 years presenting to our out patients department (OPD) primarily with nail complaints. A detailed history of the disease was taken, and all the 20 nails were examined. Relevant investigations (KOH scraping, pus culture sensitivity, or biopsy) were performed. Results The age of the patients varied between 18 and 85 years, with a mean value of 35.37±15.16 years. Male to female ratio was 1:1.06. About 24 patients belonged to the geriatric age group. In all, 50 (20%) patients had their disease directly related to their profession. The most common presenting complain was discoloration followed by deformity. Finger nails were more commonly involved. The most common diagnosis was onychomycosis (55.6%), followed by traumatic nail (6.4%), chronic paronychia (4.4%), acute paronychia (3.6%), lichen planus (3.6%), onychocryptosis (3.6%), and eczematous nail changes (1.6%). Conclusion Onychomycosis is the most common primary nail apparatus abnormality responsible for discoloration of nail presenting to dermatology OPD, followed by nail trauma, paronychia, lichen planus, and onychocryptosis.