Background: The skin microbiome is a site-specific, dynamic ecosystem tightly linked to barrier integrity and cutaneous immune regulation. Athletes are repeatedly exposed to high sweat loads, friction, and prolonged occlusion from sportswear and protective gear, alongside shared environments that facilitate microbial transfer. Aim: To synthesize and critically evaluate evidence on how sweating and occlusive sportswear alter the athletes’ skin microbiome and to discuss implications for cutaneous immunity and sport-related dermatoses. Material and methods: This narrative review synthesizes current evidence from foundational and contemporary literature addressing skin microbiome ecology and its modulation under athletic conditions. Evidence was organized thematically across: baseline microbiome biogeography and stability, immune–microbiome interactions (including antimicrobial peptides), sweat and pH physiology, textile–microbiome interactions, and athlete-relevant clinical outcomes (MRSA colonization, dermatophytosis, acne mechanica). Results: Sweating and heat adaptation shape skin microclimates and secretions that act as ecological filters on microbial communities. Occlusion increases hydration and temperature, perturbs pH, and can compromise barrier function—conditions that favor dysbiosis and facilitate survival and transfer of microbes via textiles. Deodorant/antiperspirant use measurably shifts axillary microbiota. Athlete-relevant risks include increased Staphylococcus aureus carriage and outbreaks in contact settings, dermatophyte transmission (tinea gladiatorum), and friction-occlusion inflammatory dermatoses (acne mechanica). Conclusions: Sweat and occlusion synergistically create a “high-risk microenvironment” for microbiome imbalance and cutaneous immune stress. Prevention should prioritize microclimate management (rapid de-occlusion, laundering, moisture control), barrier-sparing cleansing, and sport-specific infection control while avoiding unnecessary antimicrobial pressure.
Dynowska et al. (Mon,) studied this question.