The leukotrienes, a family of highly potent biological substances derived from arachidonic acid, are suggested to play an important role in the development of tissue inflammation.¹ Leukotriene B₄ (LTB₄) is a major player whose synthesis is mainly controlled by 5-lipoxygenase. Among several diseases, hyperkeratotic inflammatory skin diseases and especially psoriasis seem to respond to LTB₄ inhibitors.² Recent study findings indicate the potential involvement of the arachidonic acid pathway in the development of inflammation in acne and provide logical support for the use of LTB₄ inhibitors in acne treatment.³

Therefore, we evaluated the role of zileuton (4 × 600 mg/d by mouth for 3 months) on moderate inflammatory acne in a small cohort of 10 consecutive patients (4 female, 6 male; median age, 17 years) in an open label drug, industry-independent study that was approved by the ethics committee of the University Medical Center Benjamin Franklin (Berlin, Germany). Zileuton [(±)-1-(1-benzo[b]thien-2-ylethyl)-1-hydroxyurea], is an orally active and selective 5-lipoxygenase inhibitor, approved in the United States for the treatment of asthma (Zyflo; Abbott Laboratories, Abbott Park, Ill).² All patients provided written consent, had not received topical or oral acne therapy for at least 1 month, and had never received oral isotretinoin or anabolic steroids. The use of cleansers and personal care products were prohibited during the study. Patients who had atypical disease such as gram-negative folliculitis were not included. Patients also were not included if they had any other disease, were pregnant or breast- feeding, were taking any other medications, or were using any form of hormonal contraception (women).