Skin wounds open the door for harmful organisms, risking infection and disrupting the skin’s microbial balance. Initial care typically involves thorough cleaning and disinfection to prevent infection. While antibiotics are sometimes used, they can also disrupt beneficial bacteria and potentially slow healing. With growing concerns about antibiotic resistance and side effects, probiotics are emerging as promising alternatives.
In this IPA blog, we delve into studies on how changes in the microbiome of various acute and chronic skin wounds impact wound healing and tissue regeneration. The potential of probiotics to help manage infected wounds and enhance tissue repair and healing outcomes is also examined.
Wound healing, in brief
As the body’s largest organ and frontline defense, skin serves as a critical barrier to the outside world yet remains vulnerable to injury; when wounded, it undergoes a remarkably efficient repair process that unfolds in four coordinated stages—hemostasis, when bleeding is stopped; inflammation, when immune cells clear debris and pathogens; proliferation, when new tissue forms; and remodeling, when structure and function are restored.
Each stage relies on intricate molecular cascades, cellular communication, and interactions with the skin microbiota.
Wound healing is a time-dependent process: most injuries are acute and resolve within days or weeks, depending on the size of the wound, but underlying factors—such as immobility, neuropathy, venous insufficiency, genetic mutations, or obesity—can impede recovery. Wounds lasting more than three months are classified as chronic, posing serious health risks due to prolonged barrier disruption.
Both acute and chronic wounds are vulnerable to infection, as the disrupted skin barrier allows pathogens to enter. In acute wounds, infection causes obvious signs—pain, swelling, and delayed healing—enabling prompt intervention. In chronic wounds, slow healing, comorbidities, and neuropathy can mask infection, making early detection difficult and increases the risk of severe complications.
Antibiotics are commonly used to treat wound infections, but they can disrupt beneficial microbes and, with rising resistance, are becoming less effective; for example, infections with multidrug-resistant organisms in diabetic foot ulcers are linked to higher rates of amputation and mortality.
The growing limitations of antibiotics have spurred the search for alternative strategies to prevent infection and promote healing. One promising approach is microbiome modulation, which aims to leverage beneficial microbes to restore balance, control inflammation, and support tissue repair.
Skin microbiome and wound healing
The skin hosts roughly a billion microbes per square centimeter, and its microbiome helps maintain local homeostasis by regulating immune responses. When this balance is disrupted and pathogenic microbes dominate, the result can be inflammation and infection.
Wound formation alters the skin microbiota, reducing beneficial species and allowing thermophilic and/or environmental microbes to colonize, as seen in burns and penetrating injuries.
For example, in a study with burn patients, the skin microbiome was significantly altered, with shifts in bacterial communities linked to wound infection, sepsis risk, and other post-burn complications.
These microbial shifts not only reflect environmental exposure and changes in the wound environment but also influence the wound-healing process and its prognosis.
Probiotics and wound healing mechanisms
Research suggests probiotics may enhance wound healing by stimulating collagen production, angiogenesis (new blood vessel growth), wound contraction, and secretion of growth factors. They also reduce pathogenic bacterial load while modulating local immune responses, creating an environment that favors faster repair and improved skin barrier function. Some commensal skin bacteria influence the production of antimicrobial peptides (AMPs), which protect against infection, decrease inflammation, and help prevent biofilm formation.
Biofilms in chronic wounds
Biofilms are microbial communities embedded in a protective extracellular matrix that shield pathogens from host defenses and antibiotics. They deploy multiple strategies that thwart healing. Biofilms resist clearance, coordinate survival through quorum sensingto regulatemicrobial behavior and virulence, and sustain chronic inflammation, which prevents wounds from progressing to the healing phase. Biofilms also support polymicrobial interactions that enhance persistence, driving infection, impaired repair, and delayed wound closure—hallmarks of chronic wounds.
Indeed, chronic wounds—including diabetic foot ulcers, venous leg ulcers, and pressure ulcers—frequently harbor biofilms. For instance, in one analysis of 50 wound samples from adult patients, biofilms were present in about 60% of chronic wounds but only 6% of acute wounds.
Once established, biofilms are extremely difficult to eliminate. They display far greater resistance than free-floating bacteria, and exposure to inadequate or inappropriate antibiotics can make them even harder to eradicate.
As a result, topical and oral antibiotics often fail and may worsen infection by disrupting protective microbes.
Probiotics in wound healing
Given the formidable defenses of biofilms and their role in sustaining chronic inflammation, researchers have turned to probiotics as a potential strategy to restore microbial balance and support wound healing. A 2024 review described a wide range of in vitro, animal, and clinical studies that have highlighted the beneficial effects and underlying mechanisms of both oral and topical probiotics in promoting wound healing.
Oral probiotics
Oral probiotics may indirectly support wound healing by improving nutrient absorption, regulating the immune system, reducing inflammation, and balancing the gut microbiota—all of which create systemic conditions that favor tissue repair. Clinical trials have reported benefits in diverse wounds, from episiotomy and oral mucosa injuries to diabetic foot ulcers and burns, with certain strains of Lacticaseibacillus casei, Limosilactobacillus reuteri, and Bifidobacterium species linked to faster healing and fewer complications.
Topical probiotics
Topical probiotics, on the other hand, may directly support the repair process. By competing with pathogens, producing antimicrobial substances, and disrupting biofilm development, topical probiotics may counteract mechanisms that perpetuate chronic wounds.
An in vitro study demonstrated that introducing probiotics into pathogenic bacterial cultures significantly reduced biofilm matrix and thickness—an effect that could translate to improved outcomes in hard-to-heal wounds. Because the experiments used culture supernatants rather than live organisms, the observed benefits stemmed from postbioticactivity.
Probiotic formulations—including gels, dressings, and lotions—have been evaluated in animal models and human studies, demonstrating benefits comparable to conventional treatments like silver sulfadiazine in burn patients. Across a range of models, probiotics have enhanced wound healing in burn injuries, diabetic ulcers, and both infected and non-infected wounds. Strains of species Lactiplantibacillus plantarum, Limosilactobacillus fermentum, and Saccharomyces cerevisiae have been studied among others, with many reports noting faster recovery marked by greater granulation tissue, higher collagen content, and increased angiogenesis.
While not all studies have observed benefits—suggesting that efficacy may depend on wound type, microbial strain, or experimental model—these findings underscore the importance of beneficial bacteria in wound care. By restoring microbial balance and supporting immune defense, probiotics represent a promising adjunct or alternative to antibiotics for improving wound healing.
Takeaway
Skin wounds disrupt the microbiome, creating vulnerability to infection, delayed repair, and chronic wounds fueled by biofilms. Antibiotics remain the cornerstone of treatment, but their limits—collateral damage to beneficial microbes and growing resistance—highlight the need for new approaches.
Probiotics may offer a promising alternative. Orally, they may strengthen immunity and temper inflammation; topically, they may compete with pathogens, disrupt biofilms, and promote tissue repair. While benefits vary by strain and wound type, mounting evidence suggests that harnessing beneficial microbes may reduce antibiotic reliance and improve outcomes in both acute and chronic wounds.
Key references
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