Topical clotrimazole and betamethasone treatments were discontinued. There was discussion of other treatment options: pausing the vismodegib therapy; beginning a course of valacyclovir, topical imiquimod or tretinoin; performing chemical peels or laser epilation. He was eventually given valacyclovir, which did not improve his condition over the few weeks he took it. Four months after developing the eruption, he agreed to try topical imiquimod, which only mildly improved his condition. The patient soon after decided to stop his vismodegib therapy, and approximately 1 month later, he began to see much improvement in his condition. On a return visit to the clinic, he had grown a beard without the formation of new spicules. He did not resume his vismodegib regimen for another 2 to 3 months, but within 2 weeks of restarting that therapy, the papules recurred. At last follow-up, pulse dosing was considered, as was imiquimod and cidofovir.