OBJECTIVE In recent years, a number of topical treatments suitable for field-directed therapy of actinic keratosis (AK) have been developed. Non-surgical treatment of AK however requires strict adherence by patients. Patients' views on the different possible topical treatments are therefore relevant to the choice of treatment. The aim of the study was to disclose the "silent perspectives" by focusing on user experiences and individual perspectives on topical treatment. METHODS Telephone interviews and face-to-face interviews were conducted with patients having had treatment with one or more of the following: imiquimod 5%, diclofenac sodium gel 3%, 5-fluorouracil (5-FU) cream 5% or photodynamic therapy. RESULTS 24 patients with AK were interviewed. Experiences of pain, discharging ulcers and efficiency of the treatment were of major importance. There was a general focus on appearance, social contacts and leisure time, although this appeared to be of lesser importance. Patients' perception of treatment instructions identified a risk of misunderstandings. CONCLUSIONS Patients are primarily concerned with therapeutic efficiency. Pain and ulcers are central indicators, but appearance, social contacts and leisure time can also be considered as additional indicators of satisfaction. A firm focus on patient instruction is suggested.