Faith and fasting in dermatology: Ethical dilemmas in pharmacologic treatment

Religion plays a significant role in shaping patients' values, behaviors that can impact health, and decision making, which can position physicians at the intersection of medical responsibility and spiritual sensitivity. Although most religions with fasting traditions, such as Islam and Judaism, prioritize health and, therefore, exempt the ill, elderly, or those needing medications from fasting, some devout individuals are adamant about fasting. Fasting introduces complex clinical and ethical challenges in dermatology, where optimal therapies may depend on consistent dosing, nutritional intake, and hydration. These factors influence treatment adherence, pharmacologic efficacy, and patient-physician communication. Such interactions generate ethical tensions between respecting patient autonomy and fulfilling the obligations of beneficence and nonmaleficence. Herein, we explore how religious observances can affect dermatologic therapeutic outcomes, particularly when pharmacokinetics or dosing schedules conflict with religious observance. We examine strategies for ethically navigating situations in which faith-based practices or commitments conflict with medical recommendations, emphasizing transparent communication, informed consent, and interdisciplinary collaboration. Through culturally sensitive dialogue and cooperative decision making, dermatologists can uphold medical integrity while honoring patients' spiritual identities and promoting patient-centered, ethically sound care.