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Lutz Schmitz, Girish Gupta, Marc Hanno Segert, Ricarda Kost, Julia Sternberg, Thilo Gambichler, Eggert Stockfleth

• \(\textbf {Background/Aims:}\) Actinic keratosis area and severity index (AKASI) is a new assessment tool to quantify the severity of actinic damage on the head. Thus far, it has not been evaluated in monitoring the efficacy of field-directed topical treatments in actinic keratosis (AK) in routine clinical practice. Thus, the aim of this study was to determine treatment outcomes by using AKASI 3 months after the initiation of topical application of diclofenac sodium 3% in hyaluronic acid 2.5% gel (DFS) in patients with AKs on the head. \(\textbf {Methods:}\) We performed a retrospective analysis of patients with AKs who had AKASI scores prior to and after treatment with DFS. \(\textbf {Results:}\) Of the 24 patients included, 20 (83.3%) showed an improvement in AKASI, 2 (8.3%) a stable AKASI, and 2 (8.3%) a worsening of AKASI after a median (interquartile range) follow-up period of 91.5 days (89.8–104.3). The median AKASI reduction was 31.4% (16.7–59.1). The Wilcoxon test showed significant differences (\(\it p\) = 0.0008) between baseline and posttreatment AKASI values. \(\textbf {Conclusions:}\) AKASI is an easy-to-use quantitative tool for assessing the treatment outcome of field-directed therapies. Field-directed therapies of AK should no longer be monitored by assessments based on lesion counts alone.