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!