Sun block and supplements for our patient
After discussing the risks and benefits of treatment, our patient elected to use an over-the-counter zinc oxide sun block, as well as begin beta-carotene supplementation at 60 mg/d. We slowly increased the beta-carotene to therapeutic levels, and reevaluated for efficacy. To treat the lesions on his hands, we started the patient on tacrolimus (Protopic) 0.1% ointment once daily (to avoid using a topical steroid due to his skin fragility) and a skin protectant/moisturizer (Theraseal) 2 to 3 times daily to reduce irritation.
After treatment and minimal sun exposure for several months, our patient saw a dramatic improvement in his disease, with no blistering or ulcerations noted (FIGURE 2).
FIGURE 2
A dramatic improvement
After minimizing his exposure to the sun, using tacrolimus 0.1% ointment and a skin moisturizer, and taking a beta-carotene supplement, the appearance of our patient’s hands improved. His hands were less erythematous and there were no ulcerations. Callus formation persisted.
CORRESPONDENCE David A. Kasper, DO, MBA, Skin Cancer Institute, 1003 South Broad Street, Lansdale, PA 19006; davidkas@pcom.edu