Acne vulgaris (AV) is an inflammatory skin disease of the pilosebaceous unit. There are numerous factors in the etiopathogenesis of AV. The main factors are inflammation, abnormal keratinization, microbial flora changes, and increased sebum production. The sequence in which these events occur is still not certain, but recently, inflammation has been suggested as the initial factor. The aim was to estimate elafin levels in the serum of moderate and severe acne cases versus controls and to investigate if elafin and can be used as markers for diseases severity. Methods: 80 patients were included in this study, Patients under study were subjected to the following: Full history taking , General examination, Dermatological clinical examination, and Laboratory investigations: Elafin using enzyme-linked immunosorbent assay (ELISA) technique. Results: Patients showed significantly higher Elafin levels when compared to control group (p < 0.001). In addition, paients with severe acne showed significantly higher Elafin levels when compared to moderate subgroups (p=0.005,