The skin is not just a protective barrier it is a vibrant ecosystem hosting trillions of microorganisms that play a pivotal role in health and disease. Recent advances in understanding the skin’s microbiome have transformed approaches to chronic dermatological conditions creating a new era of personalized medicine where microbiome-based therapeutics (MBTs) are at the forefront of innovation for diseases like atopic dermatitis acne psoriasis and hidradenitis suppurativa (Madaan et al., 2024; Bhat et al., 2025).

What Are Microbiome-Based Therapeutics?

Microbiome-based therapeutics are interventions designed to modulate or restore the skin’s microbial balance. These include live biotherapeutic products such as topical probiotics and commensal bacteria engineering prebiotics and postbiotics which are metabolites of beneficial bacteria and even phage therapy targeting pathogenic microbes. Instead of only suppressing symptoms MBTs seek to address underlying dysbiosis—an imbalance in microbe populations that is strongly implicated in many chronic skin diseases (Madaan et al., 2024; Liu et al., 2025).

The Microbiome’s Role in Skin Disease

Research shows that healthy skin supports a diverse robust microbial community essential for immune defense and barrier integrity. In contrast conditions like atopic dermatitis psoriasis and acne are linked to reduced diversity and the overgrowth of specific pathogens such as Staphylococcus aureus in eczema. This dysbiosis can exacerbate inflammation impair healing and worsen disease severity (Chen et al., 2025; Bhat et al., 2025).

For instance in atopic dermatitis not only is there a dominance of harmful bacteria but beneficial commensals are depleted weakening skin defenses and contributing to flares. Traditional therapies such as steroids and antibiotics may temporarily soften symptoms but can further disturb microbial balance and encourage resistance. MBTs offer a targeted and holistic alternative by restoring or supporting beneficial microbes reducing the abundance of pathogenic organisms and strengthening the skin barrier (Madaan et al., 2024).

Personalization: The Next Frontier

One of the most exciting developments in 2025 is the move toward personalized microbiome treatments. Cutting-edge diagnostic tools can now sequence a patient’s skin microbiome identifying unique microbial profiles and vulnerabilities. This information when integrated with data on genetics lifestyle and underlying skin conditions helps clinicians craft highly individualized interventions such as tailoring probiotic blends or postbiotic creams to specific needs (Madaan et al., 2024).

Artificial intelligence is further accelerating this shift allowing for rapid analysis of complex microbiome and clinical data to design bespoke treatment regimens. Personalized microbiome-targeted care promises better outcomes reduced side effects and higher patient satisfaction (Madaan et al., 2024).

Clinical Applications and Evidence

Clinical studies demonstrate important applications of MBTs:

  • In atopic dermatitis topical application of beneficial bacteria or metabolites can decrease the overgrowth of S. aureus reduce inflammation and improve skin hydration and barrier function (Chen et al., 2025).
  • In acne MBTs that support growth of Cutibacterium acnes strains with anti-inflammatory properties or use bacteriophages to target pathogenic bacteria are showing promise in reducing lesions and breakouts (Bhat et al., 2025).
  • For psoriasis and hidradenitis suppurativa alterations in the skin microbiota have been linked to disease activity. Modulating the microbiome through live biotherapeutics prebiotics or postbiotics is being actively investigated with early-stage trials indicating reduced inflammation and lesion counts (Madaan et al., 2024).
  • Postbiotics which are non-viable bacterial components and metabolites deliver the benefits of living microbes such as anti-inflammatory or antioxidant effects while avoiding safety concerns making them attractive for sensitive skin and wide consumer use (Liu et al., 2025).

Challenges and Future Directions

Despite significant progress several challenges remain:

  • Regulatory and safety concerns related to standardizing manufacturing and regulating living MBTs must be addressed with long-term studies needed to ensure efficacy and safety (Madaan et al., 2024).
  • Most current research is early stage so larger multi-ethnic clinical trials are vital to establish universal guidelines and applications (Bhat et al., 2025).
  • Integrating MBTs with standard dermatology care such as skincare immunomodulators or biologics holds great promise for lasting holistic disease control (Madaan et al., 2024).

The Road Ahead

Microbiome-based therapeutics are rapidly shifting dermatology from a one-size-fits-all model to an era of truly personalized mechanism-based care. As our understanding deepens and technologies become more accessible MBTs will likely become a standard adjunct or even first-line option for managing chronic skin diseases improving outcomes and quality of life for millions (Madaan et al., 2024; Bhat et al., 2025).

References

  1. Bhat, Y. J., Sharma, R., & Ghazanfar, K. (2025). Unravelling the role of the skin microbiome in immunodermatological diseases: Implications for therapeutic interventions. International Journal of Research in Dermatology, 11(2), 190–198. https://www.ijord.com/index.php/ijord/article/view/1945
  2. Chen, H., Li, Y., & Xu, X. (2025). Skin microbiota: Pathogenic roles and implications in atopic dermatitis. Frontiers in Cellular and Infection Microbiology, 14, 1518811. https://www.frontiersin.org/journals/cellular-and-infection-microbiology/articles/10.3389/fcimb.2024.1518811/full
  3. Liu, X., Wang, X., & Wang, Y. (2025). Microbiome and postbiotics in skin health. PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC12025169/
  4. Madaan, T., Doan, K., Hartman, A., Gherardini, D., Ventrola, A., Zhang, Y., & Kotagiri, N. (2024). Advances in microbiome-based therapeutics for dermatological disorders: Current insights and future directions. Experimental Dermatology, 33(12), e70019. https://pubmed.ncbi.nlm.nih.gov/39641544/
  5. Navigating the intersection of lasers and the skin microbiome. (2025, April 1). PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC11959326/

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