Summary  Background Pemphigus foliaceus (PF) and pemphigus vulgaris (PV) are autoimmune blistering skin diseases usually treated with high‐dose systemic corticosteroids and other immunosuppressants that may cause severe side‐effects. Plasmapheresis also has been demonstrated to be of benefit in the treatment of pemphigus. In contrast to plasmapheresis, staphylococcal protein A immunoadsorption (PA–IA) specifically removes immunoglobulin from the circulation, allows treatment of larger plasma volumes, and does not require the substitution of plasma components.

Objectives To determine the effectiveness and side‐effects of PA–IA in patients with severe pemphigus.

Methods Five patients with severe pemphigus (PV, n = 4; PF, n = 1) were treated by PA–IA. Three of these patients had been refractory to various treatment regimens. In addition to PA–IA, methylprednisolone, 0·5 mg kg⁻¹ body weight day⁻¹ was given initially and subsequently tapered.

Results In all patients, a dramatic clinical improvement was seen within 2 weeks after initiation of therapy. Patients were free of lesions after 3, 4, 4, 10 and 21 weeks of treatment, respectively. Concurrently, autoantibody levels decreased rapidly.

Conclusions PA–IA is a rational, effective, and safe adjuvant therapy for severe pemphigus and warrants wider use for this indication. A controlled study should compare side‐effects and effectiveness of PA–IA with other treatment options for pemphigus.