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 suggest that topical probiotics may promote accelerated wound closure, reduce bacterial burden, modulate inflammatory responses, and enhance collagen deposition and angiogenesis following topical probiotic application. Early clinical studies investigations remain limited to small pilot studies and case series but have reported preliminary signals of enhanced healing and acceptable short-term tolerability in small exploratory cohorts. In addition, recent advances in probiotic delivery, such as bioengineered dressings, postbiotic formulations, and nano-enabled systems designed to improve stability and therapeutic performance, are also discussed. While existing data indicate biological plausibility and early clinical feasibility, larger, well-designed randomized controlled trials and deeper mechanistic investigations are still required to confirm efficacy, clarify safety in high-risk populations, and enable responsible clinical translation.