LEVELS OF SKIN-DERIVED ANTILEUKOPROTEINASE (SKALP) ELAFIN IN SERUM CORRELATE WITH DISEASE-ACTIVITY DURING TREATMENT OF SEVERE PSORIASIS WITH CYCLOSPORINE-A

The epidermal serine proteinase inhibitor SKALP (also known as elafin) , directed against human leukocyte elastase and proteinase 3, is stron gly induced in suprabasal keratinocytes during inflammation, The prese nce of SKALP/elafin in urine has been demonstrated for several inflamm atory skin disorders, such as psoriasis, erythroderma, and erysipelas, In this study we investigated whether SKALP/elafin levels in serum an d urine of psoriatic patients can be used as a marker for disease acti vity during treatment, Patients with severe chronic disabling psoriasi s were treated for 16 weeks with cyclosporin A, which resulted in a ma rked clinical improvement as measured with the PASI score, SKALP/elafi n levels both in serum and urine were determined with an enzyme-linked immunosorbent assay (ELISA). Measurements were performed at the start of the cyclosporin A treatment, and after regular intervals up to 16 weeks, The results indicate that 1) SKALP/elafin determination in seru m rather than in urine is the preferred method, because the decrease i n serum SI(ALP levels during therapy is more pronounced and correlated better with the clinical course of the patients; 2) SKALP/elafin leve ls in serum decreased during cyclosporin A treatment (p < 0.05); and 3 ) SKALP/elafin levels in serum correlate with the PASI score (p < 0.01 ), We conclude that SKALP/elafin measurement in serum of patients with severe psoriasis provides a tool for monitoring disease activity.