Does fasting during Ramadan affect the use of topical dermatological treatment by Muslim patients in the UK?

Abstract

Ritual fasting during the Muslim religious festival of Ramadan is one of the 'Five Pillars' of Islam, and is widely observed by Muslims. Previous studies have highlighted compliance issues in patients prescribed oral medications during this period. Aim. To assess whether fasting during Ramadan influence the use of topical treatments for skin disease in Muslim patients. This was a prospective, anonymous, questionnaire survey undertaken in a dermatology centre in a tertiary hospital in the UK. Patients were asked if they would use topical treatment while fasting, and whether they would consider this a breach of their fast. We found that more than one-third of the people interviewed would not use topical treatment while fasting, and around the same number (> 30%) would also consider this a breach of their fast. Although the majority of these patients thought that using steroid-based topical products was not acceptable, a significant proportion extended this opinion to use of any cream or emollient, and even to light therapy. Gender, age, or educational level were not useful predictors of patient opinion, but there was a significant association with birthplace and likelihood of using topical treatment during Ramadan; patients born outside the UK were significantly (P < 0.01) less likely than those born in the UK to use topical treatment in the fasting period. Our study indicates that fasting may be a significant and a hitherto unrecognised cause of non-compliance with topical treatment in Muslim patients in the UK, with potential health, quality and cost implications. Ritual fasting during Ramadan is widely observed by Muslims. Previous studies have highlighted compliance issues in patients prescribed oral medications during this period, and it seems this extends to use of topical treatments for skin disease.