Topical Probiotics in Diabetic Wound Healing: Emerging Therapeutic Strategies

Diabetic foot ulcers (DFUs) are among the most serious and costly complications of diabetes, characterised by delayed healing, frequent infections, and a high risk of recurrence. Despite advances in wound care, many current therapies fail to address the multifactorial pathophysiology of diabetic wounds, including vascular dysfunction, immune dysregulation, chronic inflammation, and microbial imbalance. In this context, topical probiotics have emerged as a promising microbiome-based strategy aimed at restoring microbial balance while promoting tissue repair. This review summarises current evidence on the use of topical probiotics in diabetic wound healing, with a particular focus on DFUs, outlining key pathophysiological barriers to healing and examining how probiotic therapies may counteract these processes through antimicrobial, antibiofilm, immunomodulatory, and pro-angiogenic mechanisms. Preclinical studies consistently report accelerated wound closure, reduced bacterial burden, modulation of inflammatory responses, and enhanced collagen deposition and angiogenesis following topical probiotic application, while early clinical studies report encouraging outcomes, including improved healing rates and favourable safety profiles. In addition, recent advances in probiotic delivery, such as bioengineered dressings, postbiotic formulations, and nano-enabled systems designed to improve stability and therapeutic effectiveness, are discussed. While existing data support the potential of topical probiotics as promising adjuncts in DFU management, larger, well-designed clinical trials and deeper mechanistic studies are still needed to define optimal formulations, confirm long-term safety, and enable successful clinical translation.