Background: Chronic actinic dermatitis (CAD) is difficult to treat. Topical corticosteroids induce adverse effects after long-term use, especially on light-exposed skin. Objective: Our purpose was to study the effects of tacrolimus ointment in the treatment of elderly patients with CAD. Methods: In an open trial, 6 male patients between 51 and 80 years old with CAD applied 0.1% tacrolimus ointment twice a day to the face and neck. According to improvements, the frequency of application was reduced. Sunscreen agents were also applied outdoors. Results: Tacrolimus ointment effectively treated cutaneous changes in all patients. Symptoms were moderately improved in 2 weeks, and greatly in 4 weeks. A brief and localized irritating sensation occurred in all patients, but no other adverse events developed throughout the study course from 0.5 to 2.5 years. Conclusion: Topical tacrolimus ointment for facial lesions of CAD appears to be effective and well tolerated and may provide long-term benefits. (J Am Acad Dermatol 2002;47:881-4.)