An increase in the serum concentration of granulysin or soluble Fas ligand (sFasL) is seen in patients with Steven-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). The rise in these proteins is not seen in most other drug-related skin disorders.


Granulysin is a member of the saposin-like protein family of lipid-binding proteins and is cytotoxic.


Fas ligand is a member of the TNF superfamily and serves as the ligand for FAS. It is critical for triggering apoptosis.


The serum levels of these proteins start to increase before the development of skin lesions and decrease rapidly within a week of disease onset. The proteins can also be found in the blister fluid of the established skin lesions.


Because serum levels of granulysin are significantly higher than sFasL it may be easier to monitor.


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