AAD 2026: Dermatologist Calls for Greater Inclusion of Older Adults in Skin Disease Research

Itch and aging are more deeply connected than many clinicians may appreciate, and understanding that relationship is reshaping how dermatologists approach both diagnosis and treatment, according to Daniel C. Butler, MD. Butler, a board-certified dermatologist at the University of Arizona in Tucson and director of the university's inflammatory and aging skin research program, spoke with Dermatology Times at the 2026 American Academy of Dermatology Annual Meeting.

Butler's entry into itch research came through his broader interest in aging. The immune system, the nervous system, and the skin barrier are all central to itch pathophysiology and each are independently influenced by aging, he explained. Thus, itch becomes a useful proxy for understanding how skin changes over time.

A New Framework for Understanding Itch

Butler told Dermatology Times that the clinical schematic for itch has evolved considerably over the past decade. The old model we overly simplistic, and a more nuanced framework has emerged. "About 10 years ago, the schematic of itch was basically rash/no rash," he explained. “If they had a rash, you look at the rash, you diagnose the rash based on morphology. If they don't have a rash, then you order a set of labs and look for an internal cause. And if they don't have either of those, You just sort of roll your eyes.”

The framework he now applies considers 3 overlapping systems: immune, neurologic, and what he calls the primary cutaneous system, meaning barrier function.

Many patients, particularly older adults, do not fit neatly into 1 category. "What we find in many itch patients, and particularly older adult patients, is they're a Venn diagram," Butler said in an interview with Dermatology Times. "They have a little bit of immune, they have a little bit of nerve, and then they have a little bit of barrier dysfunction." Recognizing which systems are involved, he said, opens up multiple therapeutic targets and helps explain why certain treatments work when they do.

The Trial Exclusion Problem

Butler's also discussed the structural gap in dermatology research: older adults are routinely excluded from clinical trials, both through explicit age cutoffs and through comorbidity exclusions that disproportionately screen out this population. Conditions like hypertension and hyperlipidemia are common grounds for exclusion, he noted, yet these are precisely the comorbidities that older patients are most likely to carry.

The lack of research data results put prescribing clinicians at a disadvantage. Butler framed the issue in terms of what data actually enables clinicians to do. "A prescriber's greatest gift isn't just to give a medication," he told Dermatology Times. "What the prescriber does is they guide and they coach a patient through the journey of being on a medication. And the only way we can do that is with data."

Without that data, he said, clinicians become less effective and more hesitant, often avoiding medications altogether when they lack the evidence base to counsel patients and caregivers through side effects and monitoring. "We use dangerous medications all the time because we know how to use them… We know how frequently to check in with them, for them to follow up with us, to order labs, which labs to order," Butler said. "It's really when we don't have data where we become much less effective."

He acknowledged some positive movement in this area, noting that as effective treatments have emerged for diseases common in older adults, trial populations have become more inclusive. “The good news is that we're seeing much more inclusivity and we have to continue to advocate for that.”

Butler said his research group and the AAD are actively working to continue that progress. He pointed to the AAD's geriatric dermatology expert resource group that convened at the AAD. He described it as the largest gathering of geriatric dermatology-focused clinicians in the world, which makes it a key venue for advancing these conversations.

What He Is Watching at AAD

Beyond his own session, Butler told Dermatology Times he is paying close attention to the wave of new inflammatory disease treatments making their way to market. New psoriasis therapies, mast cell-targeted agents, and oral medications targeting different parts of the JAK inhibitor pathway are all on his radar, and he sees each as a potential asset for older adult patients as safety profiles continue to improve. "Each one of these, as they come out with cleaner and cleaner side effects, becomes a really wonderful option for our older adults," he said. He added that understanding how these agents can support shared decision-making with older patients is a priority for his group going forward.

Additional coverage of the 2026 AAD Annual Meeting can be found here.

References

1. Butler DC. Side Effects May Include: Illustrative Cases of Dermatologic Adverse Events. Presented at the 2026 American Academy of Dermatology Annual Meeting; March 27-31, 2026; Denver, Colorado.

2. Butler DC. Cutaneous Immunosenescence and Itch: The Science Clinical Relevance of Skin Aging. Presented at the 2026 American Academy of Dermatology Annual Meeting; March 27-31, 2026; Denver, Colorado.