TOPICAL CORTICOSTEROIDS AND THE SKIN MICROBIOME: A MISSING PERSPECTIVE IN IMMUNE REGULATION AND DISEASE MANAGEMENT

Abstract

The skin microbiome is a complex community of bacteria, fungi, and viruses that essentially determine the cutaneous immune homeostasis and barrier activity. Topical corticosteroids continue to be the foundation of anti-inflammatory intervention in many dermatological conditions, although their effect on microbial ecology is not properly defined. Although the immunosuppressive effects of corticosteroids are thoroughly studied, their two-way communication with the skin microbiome is an essential knowledge gap in modern dermatology. This review critically analyzes the interplay between topical corticosteroid treatment and skin microbiome interactions and gauges existing evidence on steroid-related changes in microbes and their effects on immune homeostasis and disease control. Corticosteroids have therapeutic actions in which they act by suppressing pro-inflammatory transcription factors, specifically nuclear factor-kappa B (NF-kB). At the same time, these agents also regulate expression of cutaneous antimicrobial peptides, affect lipids of the skin barrier, and may cause dysbiotic aconditions, which can affect the outcome of treatment and relapse of disease.What is missing in the current literature is that the efficacy of corticosteroid immunosuppression is extensively00 discussed, and insufficient attention is paid to microbial ecology. There was a significant lack of longitudinal studies to monitor the changes in microbiomes under steroid treatment and the medical significance of the steroid-induced dysbiosis is not well established. The potential integration of microbiome science with the use of corticosteroids therapy will provide the possibility to offer personalized dermatological interventions, microbial-friendly formulations, and combination therapy that would maximize the anti-inflammatory drug effect without disrupting the normal microflora. The future directions in this area should be the longitudinal microbiome studies, mechanistic research on hostmicrobe-steroid interaction, and the formulation of microbiome-protecting therapeutic approaches