Key Insights on the Use of JUBLIA (efinaconazole) 10% for Onychomycosis

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Dr. Vlahovic discloses that she is a consultant for Ortho Dermatologics.

Hi, my name is Dr. Tracey Vlahovic, and I'm a clinical professor at Temple University School of Podiatric Medicine in Philadelphia, Pennsylvania.


I really love to talk about nail physiology. I know that's really dorky, but I love discussing how the process of onychomycosis unfolds and why it's so frustrating. First of all, it's an infection. We never want to lose sight that it's an infection. But how the fungus takes hold within the nail unit to me is fascinating.


So Trichophyton rubrum, the most common dermatophyte in the world, loves and thrives at the pH that our toenails naturally are at. And when it takes hold into the nail bed where the infection begins, it secretes ammonia, and that ammonia changes the pH of the nail, which renders the skin's immune system to be not so effective. So it explains why our patients with nail fungus suffer the way that they do, because your body's not naturally figuring out that this infection exists. It's not naturally trying to fight it. It's something that will not go away unless we treat it with some pharmaceutical agent, oral or topical. And of course, there's some people who like to use devices as well, or combinations of all of the above.

The point is is that this, I always tell my patients, doesn't matter that it's there. Their body doesn't care that it's there. I have to do something to get your body to figure out there's an infection here, and we have to kill that infection. So it's really a fascinating pathophysiological construct that's happening with onychomycosis. And I think oftentimes, we don't discuss that in podiatry. How does this begin? What's the grassroots that's happening here with toenail fungus that's taking it from a dermatophyte on the skin to the visual changes that we're seeing and the patient coming in? There's a process that's happening that is changing these patients' nails and there's a reason why our body's just saying, it's there, but I'm not going to do anything. And that's why we have to give these pharmaceutical agents to these patients.

So efinaconazole, JUBLIA, is a topical product that came out several years ago. I was actually involved as a phase three clinical investigator, principal investigator. So I've worked with this medication before it ever had a name, before it was ever on the market. And what's really been fascinating for me as a clinician and also as a researcher is to see how it has changed people over time. When you're doing a clinical trial, I'm blinded, the patient's blinded, so I really can't tell what the patient has. You certainly see nail changes, but I'm not privy to some of the testing and things like that so that I'm not unblinded. But certainly, when it's my clinical patients and I'm following them along closely over the year or year and a half that they're using it, it's fascinating to see their nail changes and also, their feelings about their nails, that they feel that their nail's changing and it's improving and they're feeling better about themselves. And that's a really wonderful thing as a clinician.

Where JUBLIA or efinaconazole fits into an algorithm, well, it's FDA-approved for mild to moderate onychomycosis. It's up to about 50% involvement. But ultimately, where it truly fits in in the algorithm is for mild to moderate nail disease. And again, that's what it's FDA approved for.

Ultimately, JUBLIA has been very instrumental in my practice to use for patients who want topical therapy, who need topical therapy. And it's great to have something that is easy for patients to use, that dries quickly, and it's also clear. There have been studies that have shown that we can use two coats of nail polish, that JUBLIA will penetrate through two coats of nail polish, and that makes our patients feel a little bit better, that they can camouflage and treat their nails at the same time. So especially when it's the summertime or if you're in a place that has perpetual sandal use year round, it's lovely to have that option where patients can camouflage and treat at the same time.

But ultimately, a lot of patients would prefer a topical therapy because they don't want to take something by mouth. So it's great to have the data that we do with JUBLIA, as well as the years of use that have shown its efficacy, and again, its safety profile. Thanks for listening, and I appreciate you tuning in.