Does Dermatology Care Meet the Unique Needs of Muslim Patients in the US?

🔍 Key Finding This mixed-methods study found that Muslim patients in the US have unique dermatologic needs related to religious practices (e.g., medication ingredients, gender concordance, modesty) and are impacted by cultural stigma, Islamophobia, and colorism, influencing their comfort discussing these needs with dermatologists. Integrating religious considerations into cultural humility training and increasing workforce diversity could improve care for this population.

🔬 Methodology Overview

• Design: Qualitative mixed-methods study (survey and semi-structured interviews)
• Setting: Two clinical sites within a large academic health care system in California.
• Participants: 21 adult, English-speaking, Muslim patients evaluated by a dermatologist between January 2022 and January 2023.
• Data Collection: Surveys assessing demographics, religious practices, and experiences with bias; Semi-structured interviews exploring experiences in dermatology care, accommodations, and future interventions.
• Data Analysis: Thematic analysis of interview transcripts using Dedoose software; Descriptive statistics for survey data.
• Recruitment: Retrospective medical record review to identify eligible patients followed by telephone recruitment.

📊 Results

• Demographics: 21 Muslim patients (76% female, 24% male; mean age 36.4 years) participated. 52% identified as Middle Eastern, 38% as South Asian. 62% of female participants wore hijab.
• Dermatology Care Familiarity: Participants often lacked familiarity with routine dermatologic care and preventative measures like skin cancer screenings, expressing interest in community-based educational interventions.
• Stigma: Participants reported experiencing community and religion-based stigma related to skin disease and cosmetic care, sometimes hindering open communication with dermatologists.
• Bias: Prior experiences with Islamophobia and colorism outside the clinic affected the patient-dermatologist relationship and disclosure of needs. Instances of bias and poor cultural humility from dermatologists within the clinic were also reported.
• Cultural and Religious Needs: Key needs included clinician gender concordance (especially for sensitive examinations or cosmetic procedures), adjusting medication schedules during Ramadan, and access to halal medication ingredients.
• Modesty: Modesty during physical exams was important. Participants valued clear communication and the uncovering of only necessary skin areas at a time.
• Impact of Skin Disease on Religious Practices: Skin conditions sometimes interfered with religious practices like wudu (ablution) and prayer. Conversely, religious practices like wearing a kufi or keeping a beard sometimes exacerbated skin conditions.

💡 Clinical Impact This study highlights the need for dermatologists to integrate religious considerations into culturally humble care, including awareness of modesty preferences, medication ingredient concerns, and the impact of religious practices (like fasting) on skin disease and treatment adherence. This could lead to changes in clinical practice such as clearer medication labeling, increased dermatologist diversity, and incorporating religious holidays into clinic scheduling.

🤔 Limitations

• Limited external validity due to small sample size from a single US tertiary care center.
• Exclusion of non-English-speaking patients, potentially biasing results.
• Use of video conferencing software transcriptions instead of verbatim transcriptions.
• Potential bias toward more religious participants.
• Recruitment method may have led to underrepresentation of participants who have experienced Islamophobia.
• Limited generalizability to all geographic areas and Muslim subgroups.
• Lack of representation of other Muslim groups, such as Black Muslim adults.

✨ What It Means For You Dermatologists should integrate religious considerations into cultural humility training, particularly for Muslim patients, addressing modesty preferences, medication ingredient concerns (halal), and fasting practices during Ramadan. This includes clearer communication, shared decision-making regarding treatment plans, and increased awareness of potential stigma surrounding skin disease and cosmetic care within the Muslim community. Furthermore, increasing diversity within the dermatology workforce may improve patient comfort and trust.

Reference El-Banna G, Rezaei SJ, Chang M, Merrell SB, Bailey EE, Kibbi N. Perceptions of US-Based Muslim Patients of Their Dermatology Care. JAMA Dermatol. 2023;160(1):45-53. https://doi.org/10.1001/jamadermatol.2023.4439