Microbiome-Targeted Therapies for Acne Management: A Patient-Centric Evidence Review

Background: Acne vulgaris, a chronic inflammatory skin condition, significantly impacts physical health and psychosocial well-being, often persisting into adulthood and causing substantial psychological distress, including increased risks of depression and, in severe cases, suicidal ideation. Traditional treatments, while effective, are limited by side effects, antibiotic resistance, and poor patient adherence. Recent research highlights the role of skin and gut microbiome dysbiosis in acne pathogenesis, shifting focus from Cutibacterium acnes proliferation to microbial imbalance, prompting exploration of microbiome-targeted therapies that prioritize patient-centric outcomes.Methods: A systematic literature search was conducted across PubMed, Scopus, and Cochrane Library, targeting primary research articles from 2014 to 2025. Keywords included "acne vulgaris," "skin microbiome," "gut microbiome," "probiotics," "prebiotics," "synbiotics," "bacteriophage therapy," "patient-reported outcomes," and "quality of life." Randomized controlled trials and well-designed clinical studies evaluating microbiome-targeted therapies and reporting patient-centric outcomes (e.g., quality of life, patient satisfaction, adverse events) were included. Data were synthesized thematically, focusing on clinical efficacy, microbiological changes, and patient-reported outcomes.Results: Emerging therapies, including oral and topical probiotics, prebiotics, synbiotics, and bacteriophage therapy, restore microbial balance, modulate immune responses, and enhance skin barrier function. These approaches demonstrate favorable safety profiles, improving patient satisfaction and adherence compared to conventional treatments. Probiotics reduce lesion counts by up to 67%, while synbiotics enhance gut health and short-chain fatty acid production. Bacteriophage therapy selectively targets pathogenic C. acnes strains, showing preclinical promise. Patient-reported outcomes (PROMs) and quality of life (QoL) are critical success measures, though methodological heterogeneity and limited long-term data persist.Conclusions: Microbiome-targeted therapies offer promising, patient-friendly alternatives for acne management, emphasizing clinical efficacy and psychosocial well-being. However, standardized methodologies and longitudinal studies are needed to validate long-term efficacy and enable personalized approaches. Future research should prioritize biomarkers, combination therapies, and digital health tools to enhance patient adherence and outcomes, fostering holistic, sustainable dermatological care.