The 2026 Global Delphi Consensus on Acne and the Microbiome: A Source-Checked 2026 Briefing for People With Acne-Prone Skin

The 2026 Global Delphi Consensus on Acne and the Microbiome says microbial balance helps drive acne. Nine dermatologists from seven countries agreed that protecting that balance should shape acne care. Delphi consensus means structured expert agreement reached through repeated survey rounds. Microbiome means the community of microbes living on skin and in the gut.

Medical information disclaimer: This article is for general educational purposes only and does not provide medical advice, diagnosis, or treatment. Always consult a physician or other qualified health professional about symptoms, medications, tests, or treatment decisions.

What did nine experts actually agree on?
How do daily habits affect that ecosystem?
Should probiotics be part of acne therapy?
What should acne-prone skin do now?
What are the limits of this consensus?

What did nine experts actually agree on?

The panel completed iterative rounds between May and September 2024, according to the consensus paper in MDPI Pharmaceuticals. It included acne and microbiome dermatologists from Brazil, Germany, Italy, Mexico, South Africa, Thailand and the UK. Agreement was unusually strong.

The group reached 100% agreement that the skin microbiome plays a crucial role in acne development. The model shifts away from simply having too much Cutibacterium acnes. It points instead to dysbiosis, meaning a disrupted microbial ecosystem involving strain differences, barrier damage and immune response.

How do daily habits affect that ecosystem?

The panel also unanimously agreed that skincare practices affect the acne microbiome. Harsh scrubbing, stripping cleansers and overuse of antibacterial products can disturb barrier and microbial balance. The same unanimous panel said the exposome directly affects the acne microbiome, as reported in the full consensus PDF from MDPI Pharmaceuticals.

Exposome means combined external influences such as diet, lifestyle, climate and pollution. That does not mean one food causes every breakout. It means sleep, diet patterns, humidity, sun and pollution exposure can interact with skin microbes and inflammation over time.

Should probiotics be part of acne therapy?

The panel reached 89% agreement that the microbiome affects acne severity and that the gut-skin axis directly affects acne. Gut-skin axis means signals between intestinal microbes, immunity and skin. The same majority said probiotics may offer benefit and that prebiotics, probiotics and postbiotics should be included in acne therapy.

Prebiotics feed helpful microbes, probiotics add live helpful microbes, and postbiotics use helpful microbial products. These are treatment directions, not do-it-yourself prescriptions. Strength, strain, dose, duration and safety still need clearer trial evidence before routine use.

What should acne-prone skin do now?

Choose gentle, non-stripping skincare that supports barrier and microbial balance. Practical steps include: This protective approach reflects the dermocosmetics guidance in the Journal of the European Academy of Dermatology and Venereology.

The goal is calmer, better-balanced skin rather than sterilized skin. Bring your full routine to the visit. Cleansers, retinoids, benzoyl peroxide, antibiotics and supplements all affect microbes and irritation risk.

use a mild cleanser once or twice daily without tight, squeaky dryness
moisturize to support barrier integrity
avoid picking, harsh scrubs and frequent antibacterial switching
discuss microbiome-sparing options with a dermatologist before changing prescriptions

What are the limits of this consensus?

This is expert agreement plus a narrative review of PubMed and Embase studies, not a treatment guideline proven by large randomized trials. Related authors call for robust randomized controlled trials of probiotics, secretome and donor-microbiome approaches, according to the trial protocol in BMJ Open. Mechanistic work supports the focus on balance rather than bacterial count.

Acne skin often shows dominance by more virulent C. acnes strains, lower diversity, inflammation and barrier disruption, while total bacterial load may look similar to healthy skin. Investigational options such as phage-derived endolysins and microbiome-derived indole-3-lactic acid remain experimental. Established care still centers on proven options such as benzoyl peroxide, retinoids and antibiotics chosen with a clinician.