Bacteriophage therapy for Cutibacterium acnes dysbiosis in athletes: A new frontier in precision acne management in sports medicine

Background: Athletes experience unique acne triggers – including sweat, occlusion, friction, and frequent cleansing – that can alter the skin microbiome and promote Cutibacterium acnes dysbiosis. Conventional therapies may disrupt microbial balance, induce resistance, or conflict with sports-specific needs. Objective: To evaluate the rationale, potential, and challenges of bacteriophage therapy as a precision intervention for C. acnes dysbiosis in athletes. Material and Methods: A narrative review of literature from 2010–2025 was conducted using PubMed, Web of Science, and Scopus. Search terms included “Cutibacterium acnes,” “bacteriophage therapy,” “acne,” “sports medicine,” and “microbiome.” Studies on phage biology, acne pathogenesis, and athletic dermatology were included. Results: C. acnes-specific lytic phages demonstrate high host specificity, biofilm penetration, and preservation of beneficial skin microbiota. Advances in encapsulation and topical delivery improve stability under athletic conditions. Potential applications include pre-season microbiome modulation, in-season flare control, and off-season maintenance. Challenges include regulatory classification, manufacturing scalability, and limited athlete-specific trial data. Conclusion: Bacteriophage therapy offers a promising, microbiome-preserving approach to acne management in athletes. Translational success will require sport-adapted formulations, personalized phage cocktails, and rigorous athlete-focused clinical trials.