Training, Cleansing, and the Cutaneous Microbiome: Implications for Athlete Skin Health, Infection Risk, and Performance: A Review

BACKGROUND Athletes are exposed to unique combinations of sweat, mechanical friction, frequent cleansing, and communal environments that can disrupt the skin microbiome. These disturbances lead to eczema flares, bacterial and fungal infections, acne mechanica, and impaired thermoregulation, all of which threaten performance and well-being. OBJECTIVE This review aimed to synthesize current evidence on how intensive training and hygiene practices reshape the skin microbiome in athletic populations, to examine downstream impacts on dermatologic health and performance, and evaluate emerging microbiome modulating strategies. METHODS A comprehensive literature search was performed across major biomedical databases for studies published through 2025 that addressed cutaneous microbial community composition, athlete-specific perturbations, related skin disorders, performance outcomes, and probiotic or barrier-supportive interventions. Selected articles included cohort studies, randomized trials, mechanistic investigations, and meta-analyses. RESULTS Intensive exercise elevates sweat production, raises skin pH, and causes abrasion, while repeated bathing and exposure to chlorine or detergents strip lipids and resident microbes. Shared equipment and facility surfaces can further spread pathogens. These combined factors drive dysbiosis, characterized by loss of commensal Staphylococcus epidermidis, overgrowth of Staphylococcus aureus and Malassezia species, and reduced microbial diversity. Dysbiosis correlates with atopic dermatitis exacerbations, outbreaks of impetigo and tinea, acne mechanica, and delayed barrier recovery that can sideline athletes. Early trials of topical Lactobacillus plantarum and Roseomonas mucosa show promise in restoring microbial balance in eczema, and emerging prebiotic formulations and smart textiles offer additional avenues for maintaining skin health. CONCLUSIONS Recognizing the skin microbiome as a dynamic partner in cutaneous homeostasis supports a shift from reactive treatment to proactive maintenance in sports medicine. Adoption of pH-balanced cleansers, optimized shower timing, barrier-repairing emollients, and targeted probiotic or prebiotic therapies, combined with rigorous equipment disinfection and facility design, can reduce dermatologic downtime and enhance athletic performance. Longitudinal multi-omics studies and rigorously controlled trials are needed to refine these interventions and translate microbiome science into standard care for athletes.