Best Treatment for Actinic Keratoses, Fine Lines, and Sun Damage?

Photodynamic therapy (PDT) is a great choice to
treat your problem. It will not only treat pre-malignant lesions such asactinic keratoses, including those that are not visible, but also can improveage related wrinkles. 

Nonfacial sun damaged areas such as chest and arms can benefit from a sequential chemopreventive therapy involving combination of topical imiquimod, topical 5-FU, photodynamic therapy (PDT), fractional CO2 laser resurfacing. If you were to elect to use PDT to treat sun damage for back of hands and both arms, you may need to consider lengthening incubation time beyond what would be used for the face as the skin on the arms are thicker than that of the face and would require more incubation time for the medication to penetrate across skin barrier.
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  

PDT could be a great fit for you.  I use photodynamic therapy frequently in my practice for treatment of AKs.  One benefit is that you don't the white spots (as opposed to the liquid nitrogen, which often leaves behind a white mark).  Patients in your age group really appreciate that - and you in particular given that your arms are such a great feature.  Patients often also see improvement in fine lines and sun damage as well.  Be sure to continue sunscreen and sun protective clothes to minimize further sun damage!  

Photodynamic therapy will not only treat the actinic keratoses and sun damage on your arms, but will stimulate some collagen to help your fine lines.  You must use sun protection to prevent more damage.

Photodynamic therapy is a great treatment for precancerous lesions called actinic keratoses, as the procedure globally treats the entire surface of the skin where Levulan or Metvixia is placed.  However, off-facial sites of treatment have varying responses.  I typically use longer incubation times and multiple light sources (IPL, pulsed dye laser, and blue light) to activate the photodyamic response.  Published studies on PDT have shown not only improvement of precancerous spots, but measurable improvement in sun spots (solar lentigiens), broken blood vessels, and skin texture.

PDT would be a great treatment to target both the actinic keratoses you currently see and those that are to come over the next several months. As an added bonus, it will target fine lines and wrinkles, and mottled pigmentation caused by sun damage.
My favorite regimen involves application of aminolevulanic acid (ALA) for 1 hour, followed by 16 minutes of blue light. This should then be repeated at 2 months. The face, scalp, or arms can be treated, each in a different session.
Once PDT is finished, begin your daily sunscreen...at least an SPF 30 every day. Then talk with your dermatologist about tretinoin, a prescription medication that can also treat each of these problems for years to come.

PDT would be marvelously effective for all three of your problems. In this treatment a liquid, a- aminolevulinic acid, in the form of a Kerastick, is applied to the intended target. This chemical is attracted to the atypical cells. There is a 30 minute incubation period in which you would wait in the waiting room.
Then you would be placed in front of a Blu-light or Red light ( the Blu light is probably more effective for this and the red light more effective for rejuvenating the skin) for 16 minutes. The activated (atypical) cells would be destroyed by the light.
This treatment is used for both actinic keratoses and photorejuvenation.
Usually it is covered by insurance if it is for actinic keratoses destruction purposes. Even if not, it is relatively inexpensive. The kerastick charge is $130 and the light treatment varies between $80-110.
Usually, a second treatment is administered. If you have the procedure done in the summer months you have to be VERY careful with sun exposure. We prefer doing them in the Fall and Winter, but with a cooperative patient this treatment can be utilized all year long.