Bacterial contributions to superficial skin diseases: Ecology, host interactions, and therapeutic insights

Abstract

Superficial dermatoses are traditionally attributed to fungal overgrowth, particularly Malassezia spp. However, emerging evidence highlights the significant role of the skin bacterial microbiome in modulating disease onset, progression, and severity. This narrative review aims to synthesize current knowledge on bacterial contributions to superficial dermatoses, with emphasis on microbial interactions, host responses, and therapeutic implications. A comprehensive literature search was conducted using PubMed, Scopus, and Web of Science databases. Selected studies published from 2010 to 2025 were selected based on predefined inclusion and exclusion criteria. Commensal bacteria, including Staphylococcus, Cutibacterium, and Corynebacterium, play active roles in regulating microbial balance, lipid metabolism, and inflammatory pathways. Mechanisms such as quorum sensing, biofilm formation, and enzymatic activity facilitate complex bacterial–fungal crosstalk that can either suppress or exacerbate disease. Host factors, including immune responses, skin barrier integrity, and circadian rhythms, further influence these interactions. Advances in diagnostic approaches, such as microbial profiling, enzymatic biomarkers, and volatile organic compounds, provide new insights into disease monitoring. Emerging therapeutic strategies, including probiotics, plant-derived antibacterials, metabolic modulation, and chronotherapy, show promise in restoring microbial balance and improving clinical outcomes. Bacteria are key modulators of superficial skin disease ecology and should be considered central components in disease pathogenesis and management. Integrating microbiome-based diagnostics and targeted therapeutic strategies may enhance precision dermatology and improve patient outcomes.

Keywords

Skin microbiome / Bacterial–fungal interactions / Superficial dermatoses / Host–microbe interface / Probiotics and therapeutic strategies

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