{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T01:46:04Z","timestamp":1780105564155,"version":"3.54.0"},"reference-count":56,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2025,7,18]],"date-time":"2025-07-18T00:00:00Z","timestamp":1752796800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,11,25]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>The roles played by the gut\u2013skin axis and the human microbiome have increasingly been explored in various studies. This has led to increased interest in the potential of microbiome-modulatory agents as treatments for various diseases. Probiotics have been explored as both a monotherapy for acne and as an adjunct to reduce the side-effects associated with traditional, established medications to improve patient adherence. 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 Cutibacterium acnes colonization and acne severity, supporting the use of treatments targeting the skin microbiome. However, most studies have relied on in vitro or animal models, or they have involved small sample sizes. Thus, there are limited robust clinical trial data currently available. Furthermore, researchers have tended to overlook the interplay between endogenous and exogenous factors affecting the skin microbiota. While many microbiome-modulatory products are available, their multiple ingredients require further scrutiny to isolate any beneficial components and determine whether they have any potential adverse effects. Additionally, the role that other microbial species play in acne pathogenesis requires further examination.<\/jats:p>","DOI":"10.1093\/ced\/llaf328","type":"journal-article","created":{"date-parts":[[2025,7,17]],"date-time":"2025-07-17T10:11:35Z","timestamp":1752747095000},"page":"2357-2364","source":"Crossref","is-referenced-by-count":3,"title":["Modulation of the microbiome: a paradigm shift in the treatment of acne"],"prefix":"10.1093","volume":"50","author":[{"given":"Tamara","family":"Searle","sequence":"first","affiliation":[{"name":"Imperial College Healthcare NHS Trust , London ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Firas","family":"Al-Niaimi","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Aalborg University Hospital , Aalborg ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8588-791X","authenticated-orcid":false,"given":"Faisal R","family":"Ali","sequence":"additional","affiliation":[{"name":"School of Medicine and Dentistry, University of Lancashire, Preston ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,7,18]]},"reference":[{"key":"2025112512415793800_llaf328-B1","doi-asserted-by":"crossref","first-page":"987","DOI":"10.3390\/jcm8070987","article-title":"Potential role of the microbiome in acne: a comprehensive review","volume":"8","author":"Lee","year":"2019","journal-title":"J Clin Med"},{"key":"2025112512415793800_llaf328-B2","doi-asserted-by":"crossref","first-page":"1303","DOI":"10.3390\/microorganisms10071303","article-title":"Acne, microbiome, and probiotics: the gut\u2013skin axis","volume":"10","author":"S\u00e1nchez-Pellicer","year":"2022","journal-title":"Microorganisms"},{"key":"2025112512415793800_llaf328-B3","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1007\/s13555-023-01079-8","article-title":"The microbiome and acne: perspectives for treatment","volume":"14","author":"Dessinioti","year":"2024","journal-title":"Dermatol Ther (Heidelb)"},{"key":"2025112512415793800_llaf328-B4","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1016\/j.clindermatol.2009.03.012","article-title":"The role of Propionibacterium acnes in acne pathogenesis: facts and controversies","volume":"28","author":"Dessinioti","year":"2010","journal-title":"Clin Dermatol"},{"key":"2025112512415793800_llaf328-B5","doi-asserted-by":"crossref","first-page":"1535","DOI":"10.4049\/jimmunol.169.3.1535","article-title":"Activation of Toll-like receptor 2 in acne triggers inflammatory cytokine responses","volume":"169","author":"Kim","year":"2002","journal-title":"J Immunol"},{"key":"2025112512415793800_llaf328-B6","doi-asserted-by":"crossref","first-page":"eabh1478","DOI":"10.1126\/scitranslmed.abh1478","article-title":"Antimicrobial production by perifollicular dermal preadipocytes is essential to the pathophysiology of acne","volume":"14","author":"O\u2019Neill","year":"2022","journal-title":"Sci Transl Med"},{"key":"2025112512415793800_llaf328-B7","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1007\/s40257-020-00531-1","article-title":"The skin microbiome: a new actor in inflammatory acne","volume":"21","author":"Dr\u00e9no","year":"2020","journal-title":"Am J Clin Dermatol"},{"key":"2025112512415793800_llaf328-B8","doi-asserted-by":"crossref","first-page":"2340","DOI":"10.1111\/jdv.15795","article-title":"Cutibacterium acnes phylotypes diversity loss: a trigger for skin inflammatory process","volume":"33","author":"Dagnelie","year":"2019","journal-title":"J Eur Acad Dermatol Venereol"},{"key":"2025112512415793800_llaf328-B9","first-page":"00023-15","article-title":"Strain-level differences in porphyrin production and regulation in Propionibacterium acnes elucidate disease associations","volume-title":"mSphere","author":"Johnson","year":"2016"},{"key":"2025112512415793800_llaf328-B10","doi-asserted-by":"crossref","first-page":"1908","DOI":"10.3390\/microorganisms12091908","article-title":"Microbial dysbiosis in the skin microbiome and its psychological consequences","volume":"12","author":"Borrego-Ruiz","year":"2024","journal-title":"Microorganisms"},{"key":"2025112512415793800_llaf328-B11","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1111\/bjd.18659","article-title":"Changing our microbiome: probiotics in dermatology","volume":"182","author":"Yu","year":"2020","journal-title":"Br J Dermatol"},{"key":"2025112512415793800_llaf328-B12","doi-asserted-by":"crossref","first-page":"962","DOI":"10.1001\/archderm.1930.01440180008002","article-title":"The effect on the skin of emotional and nervous states: III. 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