<p>Smart textiles have emerged as a transformative class of materials that extend the role of conventional fabrics into personalized health management. This evolution is driven by the seamless integration of textiles with flexible electronics, enabling new paradigms in skin-interfaced systems. In the exploration of novel smart textiles for skin health, microorganisms living in the skin microenvironment necessitate consideration. Skin microbiomes are essential to skin homeostasis and balance the barrier to infection. Moreover, microbes have been extensively explored as functional components in skin health monitoring and therapeutic devices. In this review, the distribution of skin microbes, interactions between host and resident microbiota, and mechanisms of microbial functions in the skin microenvironment are introduced systematically. In addition, recent progress in skin-based flexible devices for health management, and design and fabrication methods for smart textiles are discussed. However, some challenges still exist in association with the integration of microbes into smart textiles, such as the biosafety of microbes, long-term storage, and activation. This review provides a summary of innovative technologies including microencapsulation, synthetic biology, optogenetics, and artificial intelligence for microbe-integrated smart textiles. Next-generation smart textiles will hold significant promise for precision skin disease diagnostics, personalized therapeutics, skin status monitoring, and intelligence regulation.</p> Graphical Abstract <p></p>