Clinical Efficacy and Safety of Topical Microbiome Modulation for Acne Vulgaris: A Systematic Review of Clinical Studies Published Between 2020 and 2025

Abstract

Acne vulgaris is common chronic inflammatory disorder in which effective treatment should control lesions while preserving skin barrier function and microbial homeostasis. In clinical practice, standard topical therapies may cause irritation, while prolonged antibiotic exposure raises antimicrobial resistance concerns. Topical microbiome modulation has therefore emerged as a targeted strategy using postbiotics, probiotic-derived products, and bacteriophages. This systematic review evaluated the clinical efficacy and safety of these interventions. Following PRISMA 2020, PubMed, ScienceDirect, and Google Scholar were searched for primary human studies published from 2020 to 2025. Five studies met the eligibility criteria. LactoSporin reduced sebum from 106.74 ± 9.78 to 61.41 ± 7.91 µg/cm² after 21 days, a 42.4% reduction. A Lactiplantibacillus plantarum ferment lysate improved acne lesions in 59.1% of participants and reduced sebum in 72.7% by week 4. A Lactobacillus paracasei-derived lotion produced inflammatory-lesion improvement comparable with 2.5% benzoyl peroxide and fewer treatment-associated adverse effects,7.69% versus 26.92%. Bacteriophage BX001 reduced facial Cutibacterium acnes burden, although standardized clinical lesion endpoints were limited. Overall risk of bias was low to moderate, mainly because of small samples, open-label designs, and incomplete blinding. Topical microbiome modulation is promising as adjunct or alternative, but current evidence does not establish superiority over standard therapy.