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Topical Steroid Withdrawal & the Skin Microbiome

Topical Steroids & Microbiome


Topical Steroid Withdrawal (TSW) can affect the quality of life of individuals, and the fact that there is currently no cure means that this is a particularly important area of research to consider. The role of the microbiome in TSW is not yet fully understood. Although some studies have begun looking at different types of therapy as a possible new treatment for TSW, this article explores the condition and where we are we research.

What is Topical Steroid Withdrawal?

Topical Steroid Withdrawal (TSW) describes the appearance of symptoms occurring after putting an end to long-term topical steroid use. TSW can happen after immediate use of treatment, but can also happen after misuse of treatment, decreasing the strength of treatment, and applying the treatment less frequently or to fewer parts of the body.

Side effects are typically placed into two different categories; local and systemic. Local side effects describe symptoms which generally occur with prolonged treatment, and are conditional on the strength of the topical steroid, its vehicle and area of application. Most common examples of local side effects include skin atrophy, rosacea, perioral dermatitis, acne, and purpura. The other category of side effects, systemic adverse effects, are seen when very strong topical steroids are used for prolonged periods on the skin.

What is important to highlight about TSW is that there is not currently any medication that provides a cure, patients can only attempt to manage the symptom. Treatments aimed at controlling and suppressing symptoms usually include cool compresses on the skin, antibiotics for inflammation, and over-the-counter antihistamine treatment to reduce redness and itching.

Topical Steroid Withdrawal and the Skin Microbiome

The skin microbiome is made up of an organic ecosystem of trillions of bacteria that sit on the surface of the skin. It acts as a first-line of defense against the outside world, and works in a team to keep your skin healthy by fighting infection, supporting the immune system, healing wounds and controlling inflammation.

In order for the skin microbiome to work together efficiently with the human host, it needs to be balanced with a diversity of bacteria populating the skin. As the skin microbiome performs such a crucial function in keeping the skin healthy, understanding the role of the skin microbiome within the context of TSW may be essential to making progress in controlling the associated symptoms.

Next Steps For Research

The role of the microbiome in TSW is not fully explained. Considering little to know research exists on the impact of TSW on the skin microbiome, it is clear that further research should be conducted with a sufficient sample size to evaluate if a pre-/pro-/post-biotic treatment could improve the symptoms of TSW. Moreover, in order to find out whether the changes in symptoms are linked to the alterations in the microbiome community and changes in diversity, further work is required.

Sequential is a testing company with years of expertise in the field of skin microbiome and genetics. We utilise deep molecular analysis and next-generation sequencing (NGS) technology to understand the impact on an individual’s microbiome from products they use, and the effect from their environment.

All of our testing is carried out in-vivo and with the utmost care for unearthing the secrets that lie on the surface of the skin. If you are interested in carrying out any research with us and testing products, you can reach us at


Microbiome: The microbiome is a characteristic microbial community occupying a reasonably well-defined habitat which has distinct physio-chemical properties. The microbiome not only refers to the microorganisms involved but also encompasses their theatre of activity, which results in the formation of specific ecological niches. This includes their genetic material, and also structural molecules, like enzymes, membrane lipids or polysaccharides. (Definition based on Berg et al., 2020)

Skin microbiome: is present on the whole skin surface, including oral cavity and mucosal surfaces of the external genital organs. The composition of the skin microbiome is dynamic, site-specific but also differs from individual to individual. (Definition based on Byrd et al., 2018)

Probiotics: Viable (active or dormant) microorganisms added to a cosmetic product with an intended cosmetic benefit to the host at the application site, either directly or via an effect on the host microbiome, when utilized in adequate amounts.

Reference List

Moreno-Indias, I. et al. Neonatal Androgen Exposure Causes Persistent Gut Microbiota Dysbiosis Related to Metabolic Disease in Adult Female Rats. Endocrinology 157, 4888-4898, doi:10.1210/en.2016-1317 (2016).

Yurkovetskiy, L. et al. Gender bias in autoimmunity is influenced by microbiota. Immunity 39, 400-412, doi:10.1016/j.immuni.2013.08.013 (2013)


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