Modulation of the microbiome: a paradigm shift in the treatment of acne

Abstract The role of the gut-skin axis and the human microbiome has become increasingly explored in various studies and as a result, the therapeutic potential of microbiome-modulatory agents has piqued interest. Probiotics have been explored as both a monotherapy for acne but also as an adjunct to reduce the side-effects of traditional established prescriptions to improve compliance. We review the evidence to support the use of topical and oral probiotics, prebiotics and synbiotics in treating acne vulgaris. There is some evidence of a correlation between increased C. acnes colonisation and acne severity, supporting treatments targeting the skin microbiome. However, most studies rely on in vitro, animal models, or are of small sample sizes, with limited robust clinical trials currently available. Research often overlooks the interplay of endogenous and external factors affecting skin microbiota. Whilst many microbiome modulatory products are available, their multiple ingredients require further scrutiny to isolate any beneficial components and their potential adverse effects. Additionally, the role of other microbial species in acne pathogenesis needs further examination.