As dermatologists, we often encounter patients with diverse cultural and religious backgrounds, each presenting unique considerations for treatment planning. For Muslim patients, Ramadan—a month-long period of fasting observed by approximately 1.8 billion Muslims worldwide—can significantly influence dermatological care. This article provides an overview of Ramadan, explores the compatibility of topical medications, injections, and oral medications with fasting, and offers practical guidance for developing treatment plans that respect patients’ religious practices while ensuring optimal care.
Ramadan basics: What dermatologists need to know
Ramadan is the ninth month of the Islamic lunar calendar, during which Muslims abstain from food, drink, smoking, and oral intake from dawn (Fajr) to sunset (Maghrib). This fast, one of the Five Pillars of Islam, is both a spiritual discipline and a physical commitment, typically lasting 29–30 days. Fasting hours vary by geography—ranging from 12 to 18 hours in 2025 depending on location—and exemptions are granted for those with acute illness, chronic conditions requiring sustenance, pregnancy, or other health-related needs. Despite these exemptions, many patients with manageable conditions, including dermatological disorders, choose to fast, necessitating tailored treatment approaches.
Topical medications and Ramadan: religious and clinical insights
A key question for dermatologists is whether topical medications—creams, ointments, or medicated plasters—align with fasting rules. Religious scholarship has concluded that topical treatments do not break the fast. This ruling, echoed by prominent scholars like Shaykh Ibn Baz, rests on the principle that skin absorption does not equate to ingestion, as it bypasses the digestive system central to fasting prohibitions. A similar ruling is applied to medications applied intravaginally or anally. Yet, patient behavior often diverges from this consensus. A U.K. survey found that over one-third of Muslim patients with skin conditions avoided topical treatments during fasting hours, perceiving them as invalidating the fast. This reluctance extended to nonsteroidal creams and even phototherapy, revealing a disconnect between religious guidance and patient perception. Such noncompliance can exacerbate conditions like psoriasis or eczema, where consistent application is critical.
Injections: therapeutic vs. nourishing
Injections present a more nuanced scenario. Scholarly consensus holds that therapeutic injections (e.g., biologics) do not nullify the fast, as they neither nourish nor mimic eating. Conversely, nourishing injections—such as total parenteral nutrition (TPN), IV fluids, or glucose—do break the fast, functioning as sustenance substitutes. Insulin offers a unique case study: while technically insulin injections do not invalidate fasting, taking them on an empty stomach can cause life-threatening hypoglycemia. Patients on chronic insulin injections should consult a physician prior to considering fasting for Ramadan.
Patients with chronic health conditions (as well as other special cases such as pregnancy, breastfeeding, or menstruation) may be exempt from fasting, with options to make up missed days later or offer charity instead.
Oral medications: a clear fasting boundary
Unlike topicals and therapeutic injections, oral medications are universally considered to invalidate the fast by Islamic scholars, as they involve ingestion through the mouth. This poses a challenge for conditions requiring oral therapies. Dermatologists should initiate discussions with patients about adjusting oral medication schedules to suhoor (pre-dawn meal) or iftar (sunset meal) times, when intake is permitted. For example, a once-daily dose of isotretinoin could be taken at iftar to maintain efficacy without breaking the fast. However, for medications requiring multiple daily doses or strict timing (e.g., antibiotics for severe infections), rescheduling may be impractical. In such cases, if the condition is non-life-threatening and the patient prioritizes fasting, pausing nonessential oral medications during Ramadan could be considered, provided the risks are minimal and discussed thoroughly. Patients should be monitored closely for flares, with a plan to resume treatment post-Ramadan.
Practical strategies for dermatologists
To support Muslim patients during Ramadan, dermatologists can adopt the following strategies:
- Pre-Ramadan consultations: Schedule appointments 4–6 weeks before Ramadan to review treatment plans. Discuss fasting intentions, assess disease severity, and adjust regimens—shifting oral doses to suhoor/iftar or pausing nonessential drugs if safe.
- Education on compatibility: Reassure patients that topical medications and therapeutic injections are fasting-compatible while clarifying that oral medications require strategic timing or potential pausing.
- Alternative delivery methods: Explore fasting-friendly options like transdermal patches or longer-acting injectables to reduce reliance on oral therapies.
- Monitor and adapt: For severe conditions, assess fasting feasibility. If oral medications are critical and cannot be rescheduled, explain exemptions compassionately, involving religious counselors if needed.
- Cultural sensitivity: Avoid assumptions—some patients may prioritize fasting, while others may seek exemptions. Open dialogue fosters trust and compliance.
Based on the experience of myself and numerous other Muslim physicians, many Muslim patients alter medication regimens during Ramadan without professional input, risking suboptimal outcomes. Dermatologists play a pivotal role in preventing this by aligning treatment with religious permissibility. While long-term studies on fasting’s impact on medication efficacy are limited, the immediate priority is ensuring adherence through education and flexibility.
By understanding the basics of fasting and leveraging evidence-based adjustments, we can honor the spiritual commitment of Ramadan while safeguarding skin health.
Aamir Hussain is a dermatologist.
