Multiple treatment modalities have been developed for the treatment of actinic keratoses (AKs). No systematic review has been undertaken to compare the cosmetic outcomes of these various modalities. We reviewed all available publications on PubMed on the treatment of AKs. We concluded that photodynamic therapy and imiquimod have the greatest amount of evidence indicating superior cosmetic outcomes. In general there is a lack of reported cosmetic outcomes in publications on the treatment of AKs. Further research is needed in this area.