Actinic kratosis can develop dnring PUVA therapy especially at high accumulative doses(more than 1000Joules/cm) but it can also develop at low accumulative doses(lese than 200Joules/cm). PUVA therapy should be done carefully and the dermatologist has to observe the patients skin more closely to detect development of the keratosis. We present a case of multiple actinic keratoses that developed during PUVA therapy in a 53 year old vitiligo patient. They developed during relatively low accumulative dose PUVA therapy(827Joules/cm2). (Korean J Dermatol 1997;35(5): 989-993)