Pre-elafin controls keratinocyte integrity via cornified envelope formation and inhibition of desquamation, but its role in ultraviolet (UV)-induced keratinocyte apoptosis is unknown. This study examined the role of pre-elafin in volunteer skin samples and primary cultured normal human keratinocytes irradiated with phototoxic doses of UVA/narrow-band UVB, and in keratinocytes with pre-elafin overexpression/knockdown, under conditions of low and high calcium. Phototoxic doses of UV increased pre-elafin mRNA and protein expression in inverse proportion to keratinocyte survival. Pre-elafin overexpression under conditions of low calcium, which, in contrast to conditions of high calcium, was localized to the cytoplasm, increased keratinocyte apoptosis, whereas knockdown inhibited UV-induced apoptosis. Pre-elafin was co-localized with, but not bound to, cleaved caspase-3. Pre-elafin reduced cystatin-A expression, which was bound to pro-caspase-3. In conclusion, UV phototoxicity-induced pre-elafin inside keratinocytes prior to cornified envelope formation could be involved in UV-induced keratinocyte apoptosis via cystatin-A downregulation resulting in pro-caspase-3 activation.