Could a Skin Microbiome Transplant Be the Future of Acne Treatment?

In 2018, a small clinical trial at the University of California, San Diego, did something unusual: researchers swabbed the cheeks of people with clear skin, cultured the bacteria, and then transplanted those microbes onto the faces of people with acne. Within weeks, inflammatory lesions dropped by an average of 50 percent. No antibiotics. No retinoids. Just someone else's skin bacteria, applied like a toner.

The idea sounds like science fiction, but it borrows directly from fecal microbiome transplants, which have been used to treat recurrent Clostridioides difficile infections 2013 to treat recurrent Clostridioides difficile infections in the gut. If a disrupted gut microbiome can be reset with a healthy donor's stool, why couldn't a disrupted skin microbiome be reset with a healthy donor's swab?

What's actually being transplanted?

The transplant focuses on Cutibacterium acnes, the bacteria most associated with acne, though not in the way most people think. A study by Oh and colleagues found that people with acne don't have more C. acnes than people with clear skin—they have different strains of it that people with acne don't have more C. acnes than people with clear skin—they have different strains of it. Some strains produce virulence factors that trigger inflammation; others produce antimicrobial peptides that keep the skin calm. The goal of a transplant isn't to eliminate C. acnes, but to shift the balance toward the protective strains. Researchers isolate bacteria from a donor with clear skin, grow them in the lab, and apply them topically to the recipient's face. The donor microbes are meant to colonize the follicles and outcompete the inflammatory strains already there.

Does it actually work?

The UCSD trial was tiny—only a handful of participants—but the results were striking enough to warrant attention. Participants who received the microbial transplant saw reductions in inflammatory acne lesions, while those who received a placebo did not. The effect persisted for weeks after the final application, suggesting the transplanted bacteria had taken up residence. A 2018 review by Byrd and colleagues noted that the approach could represent a paradigm shift: instead of killing bacteria indiscriminately with antibiotics, we'd be curating them. The catch? The transplants need to be personalized. Not every donor's bacteria work for every recipient, likely because of differences in skin pH, oil production, and immune signaling (for more on that complexity, see our full overview of C. acnes strains and acne development).

The technical problem no one's solved yet

Even if the transplanted bacteria colonize successfully, there's no guarantee they'll stay. Your skin is not a blank slate. It has a resident community shaped by years of genetics, diet, stress, skincare, and environment. Introducing new bacteria is less like planting a garden and more like introducing a new species into an established ecosystem—there's competition, territory, and a lot of ways for the newcomers to lose. Researchers are now experimenting with "prebiotic priming"—applying compounds that favor the growth of beneficial bacteria before the transplant—to improve colonization rates. Others are looking at phage therapy, using viruses that selectively kill inflammatory strains without touching the protective ones (a topic explored in depth in our piece on whether C. acnes is really behind your breakouts). The field is still in early days, but the underlying logic is sound: acne isn't an infection to be sterilized, but an imbalance to be corrected.

Why this matters for your skin

If microbial transplants become viable, they could offer an alternative to the cycle of antibiotics and retinoids that leave many people with damaged skin barriers and recurring breakouts. The shift would be from eradication to restoration—treating your skin not as a battlefield, but as a community worth cultivating.

References

• Fitz-Gibbon S, Tomida S, Chiu BH, et al. Propionibacterium acnes strain populations in the human skin microbiome associated with acne. J Invest Dermatol. 2013.
• Byrd AL, Belkaid Y, Segre JA. The human skin microbiome. Nat Rev Microbiol. 2018.
• Nakatsuji T, Chen TH, Narala S, et al. Antimicrobials from human skin commensal bacteria protect against Staphylococcus aureus and are deficient in atopic dermatitis. Sci Transl Med. 2017.
• Grice EA, Segre JA. The skin microbiome. Nat Rev Microbiol. 2011.