# Dermatological Care During Ramadan: A Physician’s Guide

## Introduction

As dermatologists, we frequently encounter patients from various cultural and religious backgrounds, each requiring attention to develop personalized treatment strategies. For numerous Muslim patients, Ramadan—an important month of fasting celebrated by around 1.8 billion individuals worldwide—poses specific challenges for managing skin ailments. Since fasting during Ramadan necessitates refraining from food, drink, and oral medications from dawn to sunset, dermatologists must design treatment strategies that respect religious practices while ensuring effective patient care.

This article delves into the essential aspects of Ramadan, evaluates the acceptability of topical treatments, injections, and oral medications during fasting, and offers practical recommendations for managing dermatological issues in Muslim patients observing Ramadan.

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## Understanding Ramadan: Crucial Points for Dermatologists

Ramadan constitutes the ninth month of the Islamic lunar calendar and is deemed a time for spiritual reflection, devotion, and community engagement. During this period, Muslims fast from dawn (Fajr) until sunset (Maghrib), avoiding food, drinks, smoking, and oral medications.

The duration of fasting can vary based on geographical factors and may range from 12 to 18 hours in 2025. While certain exemptions apply—for individuals with chronic illnesses, pregnant women, or acute medical conditions—many patients suffering from manageable skin conditions opt to fast, necessitating customized treatment planning.

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## Topical Medications in Ramadan: Religious and Clinical Perspectives

A key concern for dermatologists involves whether patients can maintain the use of topical treatments such as creams, ointments, or medicated patches while fasting. According to Islamic legal opinions, skincare products applied externally do **not** invalidate fasting, as they are neither ingested nor absorbed into the digestive system. Esteemed scholars, including Shaykh Ibn Baz, support this perspective.

Nonetheless, a survey conducted in the U.K. indicated that over 33% of Muslim patients stopped using topical medications due to the false belief that skin absorption could nullify the fast. This misconception also impacted their willingness to engage in phototherapy and use non-steroidal creams. Since adherence is vital—particularly for chronic conditions like psoriasis or eczema—dermatologists should reassure patients that topical treatments are permissible during fasting.

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## Injections: Differentiating Therapeutic from Nutritional

The acceptability of injections hinges on their purpose and formulation. Islamic scholars typically make a distinction between:

– **Therapeutic injections (e.g., biologics, corticosteroids, intramuscular medications)** – Do **not** break the fast, as they are non-nutritive.
– **Nourishing injections (e.g., IV fluids, glucose, total parenteral nutrition)** – **Do** invalidate the fast, as they act as substitutes for sustenance.

For instance, while insulin injections do not inherently break the fast, using them without food can result in severe hypoglycemia. Patients requiring chronic injectable medications should consult their physician to modify their treatment schedule or explore exemptions.

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## Oral Medications: Defining Fasting Parameters

In contrast to topical treatments and therapeutic injections, **the consumption of oral medications universally invalidates fasting.** This creates challenges for dermatology patients who need oral therapies (e.g., isotretinoin, antibiotics, antihistamines).

To promote adherence while honoring religious practices, dermatologists should consider medication scheduling options:
– **Once-daily medications** – Suitable for administration at **iftar (sunset meal) or suhoor (pre-dawn meal)**.
– **Multiple-dose medications** – May need adjustments, including extended-release formulations or temporary cessation.
– **Crucial therapies (e.g., severe infections)** – If there are no feasible alternatives, patients might need to contemplate **exemption** from fasting, prioritizing their health.

Close monitoring is essential to reduce disease exacerbations, and tailored modifications should be made for each patient.

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## Effective Strategies for Dermatologists

To effectively assist fasting Muslim patients, dermatologists can adopt the following approaches:

### 1. **Pre-Ramadan Consultations**
– Arrange appointments **4–6 weeks prior to Ramadan** to discuss the patient’s intentions regarding fasting and evaluate their disease control requirements.
– Modify treatment plans—such as rescheduling oral doses to iftar/suhoor or halting nonessential medications when safe.

### 2. **Educating Patients on Fasting-Compatible Treatments**
– Clarify religious rulings permitting **topical treatments and therapeutic injections** during fasting.
– Inform patients that **oral medications necessitate rescheduling** or thoughtful consideration.

### 3. **Investigating Alternative Delivery Methods**
– Explore options like **transdermal patches** or **long-acting injectables** to reduce reliance on oral medications.
– Employ **night-time application schedules** for medicated creams where applicable.

### 4. **Monitoring and Adjusting Treatment Plans**
– Evaluate whether fasting is an option for patients suffering from severe dermatological conditions.
– If oral medications are vital and cannot be adjusted, consider potential solutions…