Ramasamy S, et al. - Via reviewing the literature, researchers examined the current state of the art of the microbiome and acne. Whether there is a quantitative difference in the distribution of microbial community remains unclear, making it challenging to understand any shift of community from commensal to pathogenic. It will be necessary to understand physiological changes in bacterial species and strains in order to define their specific roles and identify potential points of intervention in acne pathogenesis and treatment. It will also be essential to determine whether there are any fungal species engaged and to determine if they play an important role. Further research using robust, modern analytical tools in longitudinal studies with a large number of participants may allow determining whether the microbiota plays a causal role, is primarily involved in exacerbation, or is merely a bystander. The final outcome is likely to show that acne is the result of the complex interplay between microbe-microbe and community–host.