British Association of Dermatologists' Guidelines for the Management of Pemphigus Vulgaris 2017

K.E. Harman; D. Brown; L.S. Exton; R.W. Groves; P.J. Hampton; M.F. Mohd Mustapa; J.F. Setterfield; P.D. Yesudian


The British Journal of Dermatology. 2017;177(5):1170-1201. 

In This Article

Immunoadsorption (Strength of Recommendation D, Level of Evidence 3)

Immunoadsorption is an extracorporeal apheresis technique in which patient serum is passed over a matrix that selectively adsorbs immunoglobulin. Consequently it removes circulating pathogenic antibodies and is widely used in transplantation medicine.[224] Immunoadsorption was first used in the management of pemphigus in 1999 and several case series and reports have evidenced its utility since then.[225–227] Various matrices have been used including staphylococcal protein A and tryptophan.[226–228]

Immunoadsorption has been used together with rituximab[118,119] and other adjuvant immunosuppressive agents.[120,226,227] It is effective in difficult-to-treat disease and represents a rational approach in the reduction of circulating pathogenic antibody levels when combined with treatment directed at suppressing new antibody formation such as rituximab.[118] Daily treatment over three consecutive days can result in falls in desmoglein antibody levels of up to 95%.[228] As yet, there is no consensus on an optimal matrix or regimen, and the use of immunoadsorption should be reserved for the treatment of patients resistant to or intolerant of other approaches.


Immunoadsorption could be considered in recalcitrant cases of PV where there has been failure to improve with more conventional therapy.