Role of the Skin Microbiome in Dermatological Conditions: A Narrative Review

Background: The skin microbiome, comprising bacteria, fungi, viruses, and mites, plays a critical role in maintaining cutaneous homeostasis through immune modulation, barrier protection, and inhibition of pathogenic colonization. Emerging evidence suggests that alterations in microbial composition, termed dysbiosis, are strongly associated with the pathogenesis of various dermatological conditions, particularly acne vulgaris and inflammatory dermatoses. Understanding these interactions has become essential for developing novel therapeutic strategies. Objective: To comprehensively evaluate the role of the skin microbiome in dermatological conditions, focusing on its composition, ecological variability, host–microbe interactions, contribution to disease pathogenesis, and emerging microbiome-targeted therapies. Methods: This narrative review was conducted using a structured approach in accordance with established guidance for narrative synthesis. A comprehensive literature search was performed primarily using PubMed, supplemented by dermatology textbooks and authoritative organizational resources. Keywords included “skin microbiome,” “cutaneous microbiota,” “acne vulgaris,” “dysbiosis,” “biofilms,” “antimicrobial resistance,” “probiotics,” and “phage therapy.” Relevant studies, including reviews, randomized controlled trials, and mechanistic studies, were selected based on scientific quality and relevance. Data were synthesized qualitatively and organized into thematic domains. Results: The skin microbiome demonstrates significant spatial and temporal variability influenced by anatomical, environmental, and host-related factors. While a stable core microbiome exists, microenvironmental differences lead to distinct microbial niches. Dysbiosis, particularly involving strain-level variations in Cutibacterium acnes, plays a central role in acne pathogenesis through activation of inflammatory pathways such as IL-1β-mediated responses. Beyond bacteria, the virome and mycobiome contribute to microbial diversity and immune modulation. Antibiotic use disrupts microbial balance and promotes antimicrobial resistance, while biofilm formation contributes to chronicity and treatment resistance. Emerging therapies, including probiotics, bacteriophage therapy, and bacteriocins, demonstrate promising results in restoring microbial balance and improving clinical outcomes. Conclusion: The skin microbiome is a dynamic and integral component of dermatological health, with dysbiosis contributing to disease development and progression. Future therapeutic strategies should shift from broad-spectrum antimicrobial approaches to precision microbiome modulation, emphasizing restoration of microbial balance. Continued research is essential to translate microbiome-based interventions into effective clinical practice