Transitions challenge every company, but maybe biopharmas most of all. Drug development consists of a series of big steps, each one bringing a dramatic increase in the scale of a company’s expertise, operations, and risk-taking. Vyome is reaching the cusp of an upcoming Phase 2b trial, and it faces its greatest transition so far as a small company. With roots in India but new headquarters in Princeton, NJ, Vyome must now play for much higher stakes in focusing its dermatology portfolio on the U.S. market.