Practical Geriatric Dermatology Pearls Shared at AAD Annual Meeting

Treating older adults is less about reinventing dermatology and more about not overlooking the obvious issues, Daniel C. Butler, MD, said at the 2026 American Academy of Dermatology Annual Meeting. Butler, a board-certified dermatologist and director of the Inflammatory & Aging Skin Research Program at the University of Arizona, emphasized that subtle physiologic differences, combined with real-world barriers, can significantly alter outcomes in this growing patient population.

Adherence and Complexity: The Hidden Drivers of Poor Outcomes

Speaking with Dermatology Times, Butler highlighted a critical but often underappreciated issue: medication adherence. “Adherence rates for topical medications in older adults are much lower than for younger adults,” Butler said. While that may sound obvious, he noted that the downstream consequences are anything but trivial, especially in patients juggling multiple prescriptions and complex regimens.

In clinical practice, older adults frequently present with what Butler described as a “cascade of prescription creams,” often with unclear instructions. The result is predictable: confusion, inconsistent use, and suboptimal disease control.

Rather than attributing this to patient limitations, Butler pointed to system-level opportunities to fine-tune how clinicians prescribe and communicate with older patients. Simplification, he argued, is not optional. “For older adults, you want to make sure that you are doing your best to simplify your treatment plan,” he told Dermatology Times.

This includes limiting the number of topical agents, reducing the number of steps required for treatment, and avoiding fragmented care pathways that require multiple appointments, labs, or imaging visits. Evidence suggests that polypharmacy and complex regimens are particularly ineffective in this population, making streamlined care a practical necessity.

Knowing What Medications Don’t Mix

Beyond adherence, Butler underscored polypharmacy as a key safety concern that carries immediate clinical implications. He explained it is important to consider what other medications they may be using.

Butler shared the example of the concurrent use of prednisone and nonsteroidal anti-inflammatory drugs (NSAIDs).“If you actually look at the concurrent use of NSAIDs and prednisone in older adults, you have a 10X risk of gastrointestinal ulceration,” Butler said. The magnitude of that risk transforms what might seem like a minor prescribing detail into a potentially life-saving intervention.

Because even short courses of prednisone warrant caution, Butler advised that dermatologists should explicitly counsel patients to avoid NSAIDs during steroid therapy. Small adjustments in prescribing habits can significantly reduce harm, he said.

Treating the Patient, Not the Age

A recurring theme in Butler’s discussion was the heterogeneity of older adults. Chronologic age alone, he stressed, is a poor guide for treatment decisions.

Geriatric dermatology spans a wide spectrum, from cognitively impaired or mobility-limited individuals to highly functional nonagenarians. “We can’t just look at their age and attribute that to what they may be able to do or what treatments they want to consent to,” Butler told Dermatology Times.

His recommendation was to “live in the gray area” between undertreatment and overtreatment, tailoring care to the individual rather than defaulting to assumptions based on age.

Care Coordination and Communication: Simple Fixes That Work

For patients with cognitive impairment or complex needs, Butler emphasized the importance of expanding the care team. Dermatologists should actively engage caregivers, primary care physicians, geriatricians, and even care facilities when appropriate.

At the same time, small communication strategies can have outsized impact, he added. Writing down instructions and encouraging patients to photograph them on their phones can improve recall and adherence. “It’s really, really effective,” Butler said, noting that paper instructions are often lost, while digital access remains readily available.

Geriatric Dermatology Is Already in Your Clinic

Ultimately, Butler’s message was less about creating a new subspecialty mindset and more about recognizing existing realities. “Geriatric dermatology is… hiding in plain sight,” he said. “We are all geriatric dermatologists, if you're a general dermatologist.”

For practicing clinicians, the takeaway is straightforward: optimize adherence, simplify regimens, recognize high-risk drug interactions, and individualize care. None of this requires new technology or breakthrough therapies, just a more deliberate approach to the patients already filling dermatology clinics every day.

Reference

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.