For decades, dermatology has revolved around eliminating bacteria using antibiotics, antiseptics, and harsh cleansers. But now, a groundbreaking shift is underway one that embraces bacteria rather than destroys it. Welcome to the world of skin microbiome transplants, a novel frontier in dermatology where healthy skin bacteria are transferred to diseased skin to restore balance, treat chronic conditions, and even prevent flare-ups. Inspired by the success of fecal microbiota transplants in gastrointestinal medicine, this emerging “probiotic revolution” is redefining how we understand and approach skin health.
What Is the Skin Microbiome?
The skin microbiome refers to the diverse community of microorganisms—bacteria, fungi, viruses, and mites—that reside on the skin’s surface. Far from being merely contaminants, many of these microbes play essential roles in:
- Protecting against harmful pathogens
- Regulating immune responses
- Supporting the skin’s barrier function
- Preventing inflammation and infections
When this delicate microbial balance is disrupted a state known as dysbiosis it can contribute to a wide range of dermatologic issues including acne, eczema, rosacea, and psoriasis (Byrd, Belkaid, & Segre, 2018).
What Are Skin Microbiome Transplants?
Skin microbiome transplants (SMTs), also referred to as topical bacteriotherapy, involve applying a mixture of beneficial skin bacteria to restore microbial balance in patients with dysbiosis-associated skin disorders. These bacterial mixtures may be derived from healthy individuals or cultured in laboratories.
Unlike traditional treatments that aim to suppress bacteria, SMTs aim to restore a healthy microbial ecosystem directly on the skin’s surface.
Conditions Being Treated
Atopic Dermatitis (Eczema)
People with eczema often have a deficiency of protective bacteria such as Staphylococcus epidermidis, and an overgrowth of Staphylococcus aureus which drives inflammation. A clinical trial using Roseomonas mucosa demonstrated significant improvements in eczema severity and a reduction in steroid use (Myles et al., 2018).
Acne Vulgaris
Acne is not just about oil and clogged pores; it also involves microbial imbalances. New therapies introduce beneficial strains of Cutibacterium acnes that can outcompete inflammatory strains and reduce breakouts.
Rosacea
Though the cause is still being explored, rosacea is linked to an altered skin microbiome and demodex mite proliferation. Ongoing studies are investigating how probiotic applications can rebalance the skin flora and reduce redness and inflammation.
Chronic Wounds and Burns
Wounds are susceptible to colonization by harmful bacteria that delay healing. SMTs aim to replace these pathogens with commensal bacteria that encourage repair and prevent infection.
How It Works
Delivery systems for SMTs include:
- Topical sprays or creams with live probiotic cultures
- Medicated bandages or dressings infused with beneficial bacteria
- Direct application via swabs or masks
These microbes may integrate temporarily or permanently, depending on host compatibility and the formulation. The treatment goals include:
- Reducing harmful bacteria
- Modulating immune reactions
- Enhancing skin hydration and barrier function
Scientific Evidence and Research
The science is still young, but results are promising:
- In a phase 1 clinical trial, Roseomonas mucosa was applied topically to children with moderate-to-severe eczema. The treatment led to reduced itch, improved skin appearance, and decreased use of topical steroids without adverse effects (Myles et al., 2018).
- Byrd and colleagues (2018) emphasized that understanding skin microbial communities could lead to targeted therapeutics for conditions like acne, psoriasis, and eczema.
- AOBiome Therapeutics is developing a topical treatment using Nitrosomonas eutropha, a bacteria that metabolizes ammonia and helps maintain skin pH balance. Clinical trials are underway for acne and eczema.
Challenges and Considerations
Although SMTs offer exciting possibilities, there are hurdles:
- Live bacteria must remain stable and active in delivery formulations
- Individual skin microbiomes vary, requiring personalized treatment
- Long-term effects are still being evaluated
- Regulatory classification of live biologics remains unclear
- Public perception of applying “live bacteria” can be a barrier
Nevertheless, dermatology is moving toward ecological restoration of the skin, rather than indiscriminate eradication.
The Future of Dermatologic Probiotics
As research deepens, the potential of SMTs is expanding. In the near future, we may see:
- Customized microbial profiles used for diagnostics and therapy
- At-home microbiome kits to tailor probiotic skincare
- Preventive microbiome therapies in infants at risk of eczema or allergies
- Integration of microbiome care into standard dermatologic practice
Restoring a healthy microbiome may eventually become a cornerstone of chronic skin disease management.
Skin microbiome transplants mark an exciting evolution in dermatology. Instead of seeing bacteria as enemies, scientists and dermatologists are learning how to work with them to restore skin health. With ongoing research, this probiotic revolution holds promise for treating some of the most stubborn and recurrent dermatologic conditions, offering a safer, natural, and more holistic approach to skin healing.
References
- Byrd, A. L., Belkaid, Y., & Segre, J. A. (2018). The human skin microbiome. Nature Reviews Microbiology, 16(3), 143–155. https://doi.org/10.1038/nrmicro.2017.157
This comprehensive review discusses the role of the skin microbiome in health and disease, emphasizing the need for ecological balance in dermatologic treatment strategies. - Myles, I. A., Earland, N. J., Anderson, E. D., Moore, I. N., Janelsins, B. M., & Datta, S. K. (2018). First-in-human topical microbiome transplantation with Roseomonas mucosa for atopic dermatitis. JCI Insight, 3(9), e120608. https://doi.org/10.1172/jci.insight.120608
This clinical study highlights the safety and potential efficacy of using commensal skin bacteria as a novel treatment for eczema. - Nakatsuji, T., Chen, T. H., Butcher, A. M., Trzoss, M., Nam, S. J., Shirakawa, K., … & Gallo, R. L. (2017). A commensal strain of Staphylococcus epidermidis protects against skin neoplasia. Science Advances, 3(6), e1700649. https://doi.org/10.1126/sciadv.1700649
This research provides evidence of how certain skin microbes can offer protective benefits beyond inflammation, including anticancer activity.
