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The most commonly used topical treatment for actinic keratoses is 5-fluorouracil. This medication is an antimetabolite that works by interfering with the synthesis of DNA and RNA in rapidly dividing cells, which is critical as actinic keratoses are precancerous lesions caused by sun damage that often exhibit abnormal keratinization. 5-fluorouracil selectively targets the abnormal cells while preserving the surrounding normal tissue. Patients typically apply this treatment directly to the affected areas over a period of several weeks, allowing it to effectively destroy the atypical keratinocytes associated with actinic keratosis.

The other treatments listed have different primary uses. Hydrocortisone and clobetasol are corticosteroids primarily used to reduce inflammation and manage conditions like eczema and psoriasis, not specifically to treat actinic keratoses. Tretinoin, while helpful in promoting skin cell turnover and treating acne and some forms of photodamage, is not as specifically effective for the direct treatment of actinic keratoses as 5-fluorouracil is. Therefore, the choice of 5-fluorouracil as the suitable topical treatment for actinic keratoses is well-justified