Objective To analyze the type of onychomycosis pathogens in China, and systematically study their spatial distribution characteristics. Methods Relevant literatures in China National Knowledge Infrastructure (CNKI) and PubMed from 2010 to 2022 were systematically reviewed. Results A total of 57 literatures were included in the analysis, covering 23 provinces, municipalities and autonomous regions in China. A total of 17 292 strains of pathogens were included in the study, with at least 28 genus and 60 species. Dermatophytes (DMPs), yeast, and on-dermatophyte molds (NDMs) accounted for 59.1% (n=10 223), 35.1% (n=6 063), and 5.8% (n=1 006), respectively. The most common pathogen was Trichoton rubrum (44.9%, n=7 765), followed by Candida albicans (13.7%, n=2 371). The regional distribution of DMPs in the North was generally higher than that in the South, and the constituent ratio of DMPs gradually decreased with the geographical migration to the South. The distribution of yeast was opposite to that of DMPs, distribution of NDMs was scattered. In addition, DMPs was dominant in the climate regions with low accumulated temperature and less rainfall, yeast was more distributed in the climate regions with high accumulated temperature and more rainfall, distribution of NDMs was scattered. Conclusion The main pathogen causing onychomycosis in China is DMPs, among which Trichoton rubrum is the most important pathogen of onychomycosis in China. The spatial distribution of pathogens varies with geographical location and climate.