Background: Senile purpura is characterized by ecchymoses on the extensor surfaces of the forearms and the dorsa of hands in the elderly. The prevalence is around 10% in the eight and ninth decades. Its occurrence is secondary to the fragility of blood vessel walls caused by atrophy of dermal collagen bundles and solar elastosis due to intrinsic aging and photoaging. For prevention of senile purpura, sunscreens and barrier protection should be used. However, there has been no specific medical treatments developed for senile purpura. Objective: The purpose of this study was to evaluate the clinical efficacy of a topical calcineurin inhibitor for the treatment of senile purpura. Methods: Seven patients with senile purpura applied 1% pimecrolimus cream twice daily for 2 weeks. Efficacy was evaluated by the subject`s assessment and by the objective findings using photographic assessment. Results: There was an 8.5% reduction in the purpuric area compared with the initial lesion. When the Wilcoxon signed-rank test was used for determination of the purpuric area between the pre-treatment condition and the post-treatment condition, the therapeutic effect was statistically significant (p=0.004). Three of seven patients (42.9%) were satisfied with their treatment, and four of them (57.1%) were neither satisfied nor dissatisfied. No adverse events were observed during the treatment and follow up periods. Conclusion: This study shows that 1% pimecrolimus cream can be an effective and safe treatment modality for senile purpura. (Korean J Dermatol 2011; 49(2):119~124)