Topical therapies represent an important, yet often underutilized, mode of treatment for a wide range of dermatologic conditions. They offer targeted delivery with minimal systemic side effects. Optimal treatment with topical agents requires accurate diagnosis, appropriate drug potency, and a suitable vehicle for delivery, all of which must be tailored to the patient’s lifestyle, age-related comorbidities, and skin condition. Topical therapy is especially valuable in the geriatric population, who are at higher risk for polypharmacy and have skin changes that can enhance topical absorption. Effective management demands an understanding of drug potency, strategies to support patient adherence, and stewardship principles to prevent resistance. Education in topical therapy should be promoted, especially among non-dermatologic physicians, to improve outcomes and minimize adverse drug events and systemic toxicity.