Pathway-Specific Effects of Oral Corticosteroids on Eosinophilic Inflammation and Tissue Remodeling in Chronic Rhinosinusitis with Nasal Polyps

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a multifactorial inflammatory disease characterized by heterogeneous phenotypes and endotypes, necessitating personalized therapeutic strategies. Precision medicine approaches integrating molecular biomarkers may improve treatment selection and disease stratification. In this prospective controlled study, we investigated the tissue-level immunohistochemical effects of oral corticosteroids (OCSs) and topical steroids on the expression of periostin, eotaxin, interleukin-4 (IL-4), transforming growth factor-β (TGF-β), and tumor necrosis factor-α (TNF-α) in nasal polyp tissue. Sixty-five patients eligible for endoscopic sinus surgery (ESS) were enrolled and divided into two groups: Group 1 (n = 42) received topical steroids combined with oral prednisone (40 mg/day for 7 days preoperatively), whereas Group 2 (n = 23) received topical steroids alone. Immunohistochemical analysis demonstrated a significant reduction in periostin and eotaxin expression in both epithelial and stromal compartments following OCS therapy, accompanied by increased TGF-β expression. No significant differences were observed in IL-4 or TNF-α expression. These findings indicate that short-term OCSs selectively modulate molecular pathways associated with eosinophilic inflammation and tissue remodeling in CRSwNP, supporting biomarker-driven precision medicine strategies.