The 2026 global Delphi consensus will not change routine care yet for adults with persistent acne. Strong expert interest in microbiome care does not replace proven first-line treatment.
A Delphi consensus is a structured series of expert surveys, and here it assessed bacteria and other microbes linked to acne. Persistent acne means acne that continues from the teens into adulthood. It accounts for about 80% of adult female acne, a pattern MDedge Clinician Reviews describes as affecting up to 50% of women in their 20s, 30% in their 30s and 25% in their 40s, often as mild-moderate inflammatory disease.
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.
Table of Contents
- What nine experts agreed
- What biotic add-ons showed
- Why standard care still leads
- How adults with persistent acne can respond
What nine experts agreed
Nine dermatologists from Brazil, Germany, Italy, Mexico, South Africa, Thailand and the UK completed surveys and discussions from May to September 2024. According to MDPI Pharmaceuticals, that work produced the 2026 global consensus on acne and the microbiome, described in the consensus publication.
The panel voted 100% in favor of adopting microbiome-targeted treatments for acne management. It reached 89% agreement that the microbiome affects severity, the gut-skin axis directly affects acne, and probiotics plus prebiotics and postbiotics have therapeutic potential.
What biotic add-ons showed
A 2026 systematic review covered 33 studies with 2,112 patients aged 18-33 years. According to Medscape reporting a University of Miami review, biotic therapies produced clinically meaningful lesion reductions with favorable safety, described in the review summary.
Probiotics had the strongest evidence, mostly as add-ons to standard acne treatment for 4-25 weeks. The same review authors and commentators urged caution before changing routine care. They called for larger standardized trials on comparative efficacy, optimal strains and formulations, durability, and publication bias.
Why standard care still leads
Current US standard care remains unchanged. According to Managed Healthcare Executive reporting AAD guidelines, the American Academy of Dermatology 2024 guidelines strongly recommend topical benzoyl peroxide, retinoids, antibiotics and oral doxycycline, detailed in the guidelines report.
Oral isotretinoin is strongly recommended for severe, scarring or treatment-resistant acne. A nine-expert Delphi based on narrative review is expert opinion. According to MDPI Pharmaceuticals, it is not a regulatory approval or efficacy standard, so it cannot override guideline-backed therapy for persistent adult acne.
How adults with persistent acne can respond
Persistent adult acne often needs steady medical control rather than a product switch. The affected group is mainly adults with ongoing inflammatory lesions, not brief teen breakouts.
According to the Next Steps in Dermatology 2026 treatment review, adults should continue proven first-line regimens and consider probiotics, prebiotics or postbiotics only as adjuncts discussed with a dermatologist. Useful steps include: Bring your current product list and treatment history to that visit.
- Continue the prescribed benzoyl peroxide, retinoid, antibiotic, or isotretinoin plan
- Ask a dermatologist whether a specific biotic add-on fits your case
- Watch for new standardized trials, strain-specific dosing, and long-term safety data
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