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Jublia for Toenail Onychomycosis: Part I


Dr. Linda Stein-Gold presented on the use of Jublia for Toenail Onychomycosis (TO).  Her lecture was sponsored by Valeant. Be sure to read Part II of this blog for more information.


Dr. Linda Stein-Gold presented on the use of Jublia for Toenail Onychomycosis (TO).  Her lecture was sponsored by Valeant. Before explaining the ways in which the drug is effective for treatment, Dr. Stein-Gold provided an overview of the presentation and causes for this nail condition.

Toenail Onychomycosis is a fungal infection of the nail unit: nail plate, nail bed, and periungal tissue.  It causes discoloration, thickening and separation from the nail bed.  This is a progressive condition that requires intervention as it can lead to permanent damage and also be spread to others.  T. Rubrum is the most common cause for onychomycosis; It is responsible for 90% of cases.

In terms of diagnosis, one should note that only about 50% of the diseases of the nail are actually caused by Onychomycosis.  Psoriasis often presents like onychomycosis with distal thickening of the nail.  When looking at the toenail, you have to check for differential diagnoses:  Psoriasis, nail trauma, exogenous substances, lichen planus, neoplasms, bacterial infection, aging.

Dr. Stein-Gold listed the predisposing factors of Toenail Onychomycosis in the categories of demographic (often older males but seen in women as well, smokers), medical conditions (diabetes, immune deficiency), lifestyle/hygiene (public showers, nail salons), and climate conditions (warm locations).

There will be a diagnosis, lab confirmation and treatment goals/options in the clinic.

Clinical diagnosis

           Physical examination, concominant tinea pedis, family history

Lab confirmation

           KOH, culture, PAS, PCR

Goals of treatment

           Pharmacological: eliminate causative agent

           Physiological: restore appearance of toenail

Current “Treatment” Options

Oral Rx products

           Itraconazole capsule and tablet

           Terbinafine tablets

Topical Rx Products

           Ciclopirox topical solution

           Tavaborale topical solution

OTC Products

Homeopathic Products



Dr. Stein-Gold listed the following as the characteristics of Topical Antifungal Therapy:

  • Application to site of infection
  • No known drug interactions at therapeutic concentrations
  • No liver monitoring needed


In summary, Dr. Stein-Gold noted that the treatment goals for this burdensome condition are to eliminate the fungus and improve the toenail appearance.  Effective topical therapy may be appropriate for treatment. 

Jublia (efinaconazole) Topical Solution from Valeant Pharma has been approved by the FDA for the topical treatment of onychomycosis of the toenails due to T. rubrum and T. mentagrophytes.

In Part II of this blog, information on the efficacy and tolerability of Jublia is discussed.

Image: pedrosimoes7

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