There have been rapid gains in the field of therapeutics in dermatology over the past decade. As we move past the era of generalized topical or systemic immunomodulators and as a paradigm shift evaluate targeted treatment, it hopefully heralds the era of personalized medicine. However, effective management of a chronic, visible dermatosis necessitates consideration of diverse requirements beyond just drug therapy. This is further complicated by the onset of atopic eczema in the pediatric age group, which results in an adverse impact not only on the patient but also has a psychosocial negative impact on the family. Further, concerns include apprehensions about the impact of diet and of local and systemic adverse effects attributable to the prolonged treatment. We continue with the symposium focused on pediatric eczemas with Dr. Maitreyee Panda as the guest editor. In these two articles, authors explore the impact of diet and provide an update on topical therapies in eczema, from traditional to recent options. We sincerely hope that these symposia articles will provide the readers with an updated source of information on the management of pediatric eczemas.^[1,2]

At present, the spotlight in inflammatory dermatoses therapy is on Janus Kinase (JAK) inhibitors, drugs that cause immunomodulation by targeting the JAK-signal transducer and activator of transcription signaling pathway. This issue includes focused reviews on the role of ruxolitinib and upadacitinib in our therapeutic armamentarium, and the authors report real-world experience on the off-label use of tofacitinib and abrocitinib in the management of adult atopic dermatitis and prurigo nodularis, respectively.^[3-6]

A similar profound adverse impact on patients’ quality of life is evident while managing chronic urticaria. Therefore, it is pertinent to delve into the mind-skin (neurogenic inflammation) and gut-skin (dysbiosis and inflammation) axis. In this issue, Farouk and Abdullah explore the concept of neurogenic inflammation in chronic urticaria and delineate its implications in clinical management, and also outline future research areas.^[7] Exploring the topic of gut dysbiosis, Gupta and Gupta elucidate the diverse presentation and the impact on chronic urticaria and provide insights into the current status of elimination diets in the management of urticaria.^[8] Adding to its multiple indications, dupilumab, a monoclonal antibody blocking interleukin 4 and interleukin 13 receptor signaling, has been approved in 2025 by the United States Federal Drug Administration for the treatment of moderate to severe chronic spontaneous urticaria in adults and adolescents who fail antihistamines.^[9] Deshpande et al. provide a succinct, comprehensive review of its current status in the management of chronic urticaria that should guide the clinicians when to employ this targeted treatment in their patients with chronic urticaria.^[10]

Singh, in his article, addresses the advantage of the often maligned first-generation antihistamine chlorpheniramine with its serotonergic effects. The article highlights the potential to use its dual effect to our advantage in the management of chronic pruritic conditions with their attendant primary or secondary psychological morbidity, in which case the serotonergic effect would be beneficial.^[11] While the adverse effects of chronic therapy cannot be underestimated, it is also pertinent to note and document the continued harmful sequelae of unsupervised fixed-dose combinations such as salicylic acid, dithranol, and coal tar treatment in the treatment of endemic chronic dermatophytosis. This requires administrative intervention to prevent misguided usage and efforts to prevent their easy availability.^[12] It is also imperative to document the adverse effects of the newer targeted therapy to enable its safe incorporation in our clinical practice. Agrawal et al. report a delayed onset of rituximab hypersensitivity that warrants continued careful monitoring irrespective of prior dosage.^[13] To further explore the requirement of employing targeted therapy in urticaria, angioedema, and atopic dermatitis, we include a brief review of mobile-based patient-reported outcomes that can improve adherence and give patients a sense of control while living with a chronic dermatosis. We encourage all physicians to promote the usage of these convenient, objective outcome measures by their patients, which would also aid in monitoring and assessing the impact of biologics and small molecules.^[14]

We include interesting original research and case reports, and hope to keep receiving your contributions to the journal, which help keep the focus on the wide spectrum that allergies could present with, and each article explores and stimulates research questions that would help optimize the management of these patients. Finally, we welcome your feedback at editor@skinallergyjournal.com.