The skin microbiome: the overlooked axis in modern dermatology

The skin microbiome plays a critical role in maintaining cutaneous barrier integrity, modulating immune responses, and influencing the expression of dermatologic disease, yet its integration into clinical practice remains limited. Microbial alterations have been described in conditions such as atopic dermatitis, acne vulgaris, psoriasis, and chronic wounds; however, uncertainty regarding causality, interindividual variability, and lack of methodological standardization have hindered clinical translation. Current diagnostic frameworks rarely incorporate microbial metrics, while antimicrobial therapies remain central to management, often without consistent consideration of their ecological impact. Emerging microbiome-directed strategies, including topical probiotics, bacteriophage therapy, and microbiome-preserving approaches, show early promise but lack robust clinical validation. Advancing the role of the skin microbiome in dermatology will require standardized research methodologies, integration of multi-omics approaches, and well-designed clinical trials with clinically meaningful outcomes. This editorial highlights the need for a balanced and evidence-based framework that incorporates microbial perspectives into dermatology without overstating current evidence, advocating for a gradual integration that complements established immunologic and barrier-focused paradigms.