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This paper is a translational synthesis that consolidates peer-reviewed evidence on pericyte biology from vascular, immune, metabolic, and neuroendocrine research. It organizes these findings into a continuous account showing how pericytes function as systemic regulators whose disruption destabilizes terrain across multiple organ systems.

The analysis demonstrates how topical glucocorticoids uniquely corrupt barrier-first pericyte biology through their expression of GR, their dependence on VIP signaling, and their role in cutaneous respiration and volatile clearance. These interactions explain why Topical Steroid Rebound Phenomena (TSRP), historically misnomered TSW, emerges as a systemic recovery state.

The paper establishes TSRP as a systemic condition with pericytes as the pivotal cell type mediating collapse and recovery, and provides a coherent biological logic that accounts for rebound phenomena as predictable mechanistic outcomes rather than unexplained pathology.