Could Modifying the Skin Microbiome, Diet, and Lifestyle Help with the Adverse Skin Effects after Stopping Long-Term Topical Steroid Use?

Christopher Wallen-Russell,Samuel Wallen-Russell,Anja Gijsberts-Veens

doi:10.3390/allergies2010001

Abstract

We set up this preliminary study to begin to evaluate one main question: could strengthening the microbiome have potential benefits for the skin condition of patients suffering with adverse effects after stopping long-term topical steroid use? We aim to turn it into a much larger study if the results show the interventions might help. After commonly being prescribed for eczema, cessation of topical steroid use, especially after long periods of inappropriate use, can leave lasting adverse effects on the body and skin, known by some as topical steroid withdrawal (TSW). This preliminary study involved seven human participants suffering with skin problems associated with TSW who approached Dr. Anja Gijsberts-Veens of their own volition because they were interested in more natural recovery methods. Five completed the study in full. Progress in skin condition was tracked by self-assessed symptom severity questionnaires filled out at the beginning and end of the five-month study. The skin microbiome was addressed by using a 100% natural product shown in previous work to significantly increase skin microbiome biodiversity. Three participants implemented dietary changes and supplementation in response to guidance after fecal sample analysis, with the aim of improving gut microbiome health. The average improvement in skin symptoms for all participants was 40%, and average symptom improvement ranged from 14% for Patient 5 to 92% for Patient 1. On average, the participants saw an improvement in 85% of their symptoms and stagnation or regression in 11% and 4%, respectively. Our results suggest that the interventions used might improve the skin condition of TSW patients, but the small sample size and the lack of a control group mean that more definitive conclusions should be reserved for our follow-up work, which addresses these issues. We also aim to swab the skin of participants to assess the effect on the skin microbiome from skin and gut treatments, as well as including a more in-depth analysis of skin and gut microbiomes.

Highlights

This preliminary study was motivated by one main question: could strengthening the microbiome have potential benefits for the skin condition of people suffering with adverse effects after stopping long-term topical steroid use? If the results from this very small sample group suggest it might, we aim to expand the study to use a larger sample size and a control group to allow us to draw more reliable conclusions
The end point of the study was during the winter months when it is common for the skin condition to get worse for some people with severe eczema and topical steroid withdrawal (TSW) [44,45,47]
We will observe effects on both gut and skin. This small, preliminary study explored the idea of using the skin and gut microbiome for helping people suffering with severe skin problems after the long-term use of topical steroids, initially prescribed for eczema

Summary

Introduction

This preliminary study was motivated by one main question: could strengthening the microbiome have potential benefits for the skin condition of people suffering with adverse effects after stopping long-term topical steroid use? If the results from this very small sample group suggest it might, we aim to expand the study to use a larger sample size and a control group to allow us to draw more reliable conclusions. We aim to perform more in-depth analyses such as sequencing the skin microbiome of participants and a full gut microbiome analysis, which were beyond the remit of this study. A small cohort of seven patients was recruited who were suffering with symptoms commonly associated with topical steroid withdrawal (TSW), after having stopped the long-term use of topical steroids. To investigate the effect of these interventions, a symptoms questionnaire was given to them at the beginning and the end of the 6-month study

Objectives

Methods

Discussion

Conclusion