Pharmacology and Treatment

Background: Zileuton, a 5-lipoxygenase inhibitor, reduces the number of infl ammatory lesions in moderate acne and inhibits the synthesis of sebaceous lipids. Objective: To detect whether zileuton directly reduces sebum synthesis. Methods: A 40-year-old female with mild disseminated sebaceous gland hyperplasia and seborrhea was treated with zileuton 4 ! 600 mg/day over 2 weeks, was followed-up for 6 weeks after discontinuation of zileuton and was re-treated with low-dose isotretinoin 10 mg/2nd day over 5 weeks. Casual skin surface lipids and sebum synthesis were determined. Results: Under treatment with zileuton increased casual skin surface lipids were normalized and synthesis of facial sebum was decreased. Six weeks after discontinuation of treatment casual skin surface lipids were increased again and synthesis of sebum returned to baseline. Subsequent low-dose isotretinoin treatment led to similar changes of casual skin surface lipids and sebum synthesis with zileuton already after 2 weeks. Conclusion: Zileuton directly inhibits sebum synthesis in a transient manner with a potency similar to low-dose isotretinoin at least in our patient. Copyright © 2005 S. Karger AG, Basel Received: May 21, 2004 Accepted: July 2, 2004 Prof. Dr. Christos C. Zouboulis Department of Dermatology, Charité University Medicine Berlin Campus Benjamin Franklin, Fabeckstrasse 60–62 DE–14195 Berlin (Germany) Tel. +49 30 8445 6910, Fax +49 30 8445 6908, E-Mail [email protected] © 2005 S. Karger AG, Basel 1018–8665/05/2101–0036$22.00/0 Accessible online at: www.karger.com/drm Fax +41 61 306 12 34 E-Mail [email protected] www.karger.com Zileuton Directly Reduces Sebum Production Dermatology 2005;210:36–38 37 term treatment with oral estradiol (35 μg)/chlormadinone acetate (2 mg) (Neueunomin ® ) as well as local treatment with elubiol (Elubiol-C/Elubiol-L ® ) and subsequently with an enzyme (lactoperoxidase, glucoseoxidase)/rhodanid/lactoferrin system (DermZwo ® ) for 3 months each without clinical improvement. Histology detected enlarged sebaceous glands with markedly augmented lobules at the upper dermis. In order to detect whether zileuton directly reduces sebaceous lipid synthesis, as we have suggested before [4] , we treated the patient with zileuton at a dosis of 4 ! 600 mg/day over 3 weeks after receiving written consent. Casual skin surface lipids (CSSL) of the central forehead were always measured at 4 p.m. using a computerized photometric devise (CapilliCARE ® , BME Electronics, Marseilles, France). The measurement procedure was as follows: a glass slide was applied to the defi ned skin area by an applicator, which guarantees a similar pressure for all measurements. The slide was placed in the lector and the software photometrically measured the amount of sebum from the sample on the slide given as percentage of a stored curve representing skin surface lipids in a large population sample. To determine new sebum synthesis (NSS), defi ned areas of the central forehead and the left temple were wiped twice with ethanol after measuring CSSL. NSS was detected 1 h later using the device as described above.