In the treatment of actinic keratosis, various topical agents are used for treatment of field cancerization as well as lesional destructive treatments. In this case report,  it was aimed to present a photographic follow-up of a patient who developed severe local irritant reaction by usage of topical 5% fluorouracil but is very satisfied with the long-term anti-aging effect and to emphasize the place of 5-fluorouracil in photoaging treatment. Topical 5-Fluorouracil 5% cream therapy was recommended for widespread actinic keratosis lesions in a 67-year-old female patient who had previously undergone non-melanoma skin cancer surgery. On day 20 of treatment, a severe local irritant reaction developed. Severe local reactions were controlled by skin supportive therapy. It was observed that the patient does not have actinic keratosis recurrence in the second year following treatment, has significant improvement in photoaging and is satisfied with the treatment. Topical 5 fluorouracil treatment treats both actinic keratoses and field cancerization, prevents actinic keratoses from developing and simultaneously treats photoaging. Considering all this, topical 5-fluorouracil treatment, which is very economical, seems to be the treatment method that should be preferred in the treatment of actinic keratosis.