Saudi Pharmaceutical Journal (2013) xxx, xxx–xxx
King Saud University
Saudi Pharmaceutical Journal www.ksu.edu.sa www.sciencedirect.com
REVIEW
Skin care: Historical and contemporary views Khalid M. AlGhamdi
a,b,*
, Fahad A. AlHomoudi
c,d
, Huma Khurram
b
a
Dermatology Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia Vitiligo Research Chair, College of Medicine, King Saud University, Riyadh, Saudi Arabia c Deanship of Academic Research, Imam University, Riyadh, Saudi Arabia d Princess Noura bint Abdulrahman University, Riyadh, Saudi Arabia b
Received 1 February 2013; accepted 26 February 2013
KEYWORDS Health; Skin hygiene; Skin care; Islam
Abstract Primary prevention, specifically skin care, is an important principle in Islamic theology just as it is emphasized in contemporary medicine. Many skin diseases can be prevented by a proactive approach to skin care, such as proper hygiene and routine inspections, principles that are constantly highlighted in the Islamic literature. Islam promotes primary prevention of disease, including recommendations for skin care practices. The recommendations for skin care practices in Islamic teachings are analogous to current medical guidelines. Sun avoidance, which is recommended by Islam, is mandatory for diseases such as systemic lupus erythematosus, melasma and skin cancers. Skin care and hygiene practices are recommended in Islam and it is considered an important mechanism for reducing the transmission of infections in modern medicine. The body creases and hair are ideal sites for malicious infestations to grow. The practice of ‘‘Wudu’’ includes washing the hands, feet, and hair with clean water. It is an indispensible part of daily prayers which is mandatory for every Muslim. Oral hygiene is also an integral part of both preventive medicine and Islamic teachings. Genital hygiene, particularly after urination and defecation, is recommended in Islamic teachings and is known to prevent urinary and vaginal infections in contemporary medicine. Male circumcision is an Islamic practice. Recently, it was proven that circumcised men are less likely to have sexually transmitted diseases, including HIV. This paper reviews skin care from an Islamic perspective and its relevance to contemporary medicine by translating the simple self care principles into practical guidelines in everyday use. ª 2013 Production and hosting by Elsevier B.V. on behalf of King Saud University.
* Corresponding author. Address: Dermatology Department Director, Vitiligo Research Chair College of Medicine, King Saud University P.O. Box 240997, Riyadh 11322, Saudi Arabia. E-mail address: [email protected] (K.M. AlGhamdi). Peer review under responsibility of King Saud University.
Production and hosting by Elsevier 1319-0164 ª 2013 Production and hosting by Elsevier B.V. on behalf of King Saud University. http://dx.doi.org/10.1016/j.jsps.2013.02.005
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2
K.M. AlGhamdi et al.
Contents 1. 2.
3.
4.
5. 6.
7. 8.
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Skin care and protection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.1. Sun avoidance and Islam. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.2. Sun avoidance and contemporary medicine. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.3. Protection of the skin and Islam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.4. Protection of the skin and contemporary medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.5. General cleanliness of the skin and Islam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.6. Wudu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.7. General cleanliness of the skin and contemporary medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . The bath (ritual) in Islam. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.1. The bath and contemporary medicine. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.2. Hand and foot hygiene and Islam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.3. Hand and feet hygiene in contemporary medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.3.1. Hand hygiene . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.3.2. Foot hygiene . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.4. Oral hygiene and Islam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.5. Oral hygiene in contemporary medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.6. Nasal hygiene in Islam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.7. Nasal care in contemporary medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Hair care in Islam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.1. Hair care in contemporary medicine. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.1.1. Cleaning body hair . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Nail care in Islam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.1. Nail care in contemporary medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Genital hygiene and Islam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.1. Washing with water . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.2. Istejmar . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.3. Genital hygiene in contemporary medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.4. Genital hygiene in men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Circumcision in Islam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.1. Circumcision in contemporary medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1. Introduction The skin is the largest organ of the body and consists of epidermis, dermis and appendages such as hair, nails and sebaceous and sweat glands (Carlson, 1994). The stratum corneum, the outermost layer of the skin, is composed of dead and flattened cells (corneocytes) that form a tough, horny layer of keratin mixed with lipids, which maintains hydration, pliability, and the effective barrier of the skin (Wysocki, 1999). Approximately 10 (Krutmann and Gilchrest, 2006) particles are disseminated from the healthy skin into air each day, and 10% of these skin squames contain viable bacteria (Noble and Davies, 1965). Due to constant interaction with the surrounding environment, skin plays a key role in protecting the body against pathogens (Proksch et al., 2008). Hygiene is more than just being clean. It comprises several practices that help people achieve and maintain a healthy life. Personal hygiene not only prevents several infections from spreading but also improves individuals’ self-esteem and contributes to mental well-being. A glance into the history of medicine will clearly reveal that infections have always been a significant source of morbidity and mortality. The contagious nature of certain illnesses is well
00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00
documented, and basic control measures are usually required to combat spread of infections in a community Larson (1999)). Advances in medicine eventually led to the identification of specific disease-producing organisms and mechanisms favorable for disease transmission, which enabled the development of effective measures to prevent or control the spread of communicable diseases. Islamic teachings reveal that skin care and hygiene is integral to the religion, as indicated from the words in the Holy Quran: ‘‘Indeed, Allah loves those who are constantly repentant and loves those who purify themselves.’’ (Holy Quran, 2: p. 222). In this review, we explored Islamic recommendations for skin and related appendages, including hair, nails and mucous membranes, (Table 1) and corroborate their importance in contemporary practice of medicine. 2. Skin care and protection Skin protection has been directly addressed in the sermons by Prophet Muhammad, peace be upon him (pbuh), recommended protecting and taking care of the skin. Below are examples from hadith (Prophet’s sayings) regarding skin protection.
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Skin care: Historical and contemporary views Table 1 Components of skin care in Islam and contemporary medicine. A. B. C.
D.
E. F. G.
H.
Skin care and protection 1.Sun avoidance Protecting the skin from all impurities General cleanliness of the skin 1.Wudu 2.Bath and shower Taking care of hands and feet 1.Hand hygiene 2.Foot hygiene Keeping a healthy mouth Cleaning the nose Care of hair and nails 1.Shaving hair 2.Nail care Keeping the genital area clean 1.Washing 2.Circumcision
3 he should clean it away in case it sticks to the skin or the cloth of another person and so harms him’’ (Hajar, 1988). 2.4. Protection of the skin and contemporary medicine Transmission of infections can be prevented and controlled through the application of basic infection control precautions that can be grouped into general and transmission-specific (e.g., airborne, droplet and contact) (Green, 1984; Larson, 1997; Ekanem et al., 1991). Many diseases are transmitted by droplet and air route, including pneumonia, pertussis, diphtheria, influenza type B, mumps, and meningitis (Larson, 1997). Droplet transmission occurs when there is adequate contact between large particle droplets (>5 microns) and the mucous membranes of the nose and mouth or conjunctivae of a susceptible person (Hea, 2005). Droplets are usually generated from an infected person as a result of coughing, sneezing or talking (Xie et al., 2009). 2.5. General cleanliness of the skin and Islam
2.1. Sun avoidance and Islam One way of protecting the skin is to avoid exposure to the sun. Skin should be protected from all impurities and dirty things. Examples from the hadith (Prophet’s sayings) are shown to describe how the Prophet (pbuh) regarded skin protection. Prophet Muhammad (pbuh) advised his followers to avoid long exposure to the sun. In his book, Abu Dawod included the narration of Abu Hazim, who reported that while the Prophet (pbuh) was giving a speech, he came and sat in the sun, whereupon the Prophet (pbuh) ordered him to move, and he sat in the shade (Al-Mustadrak, xxxx).
The Prophet’s (pbuh) concern with bodily cleanliness is demonstrated from his emphasis on the ritual bath (required after engaging in sexual intercourse and at the conclusion of menstruation) (Al-Bukhari, 1987) and Wudu. Wudu (Muslims’ ablution), has specific acts including washing the exposed body parts as well as the areas between the fingers and toes with clean water. It has been said that the Prophet (pbuh) observed Wudu by washing his hands and face only once, although sometimes he washed them two or three times. According to Abdullah ibn Zaid, ‘‘The prophet was given water that fills his palm, and he rubbed out his forearms’’ (Hanbal, 1986).
2.2. Sun avoidance and contemporary medicine
2.6. Wudu
Moderate sunlight exposure has several health benefits in infants and adults. However, prolonged, direct, and unprotected sun exposure can have detrimental effects, including premature aging of the skin and the development and progression of skin cancer (Krutmann and Gilchrest, 2006; Kochevar et al., 2008). It is well known that the most effective protection against Ultraviolet (UV) radiation is sun avoidance. Limiting exposure or minimizing direct exposure during peak times and wearing appropriate clothing are also recommended (Kullavanijaya and Lim, 2005). Many dermatological diseases, including cutaneous lupus erythematosus, xeroderma pigmentosa, and dermatomyositis, are known to be aggravated by sun exposure (Yashar and Lim, 2003). Some disorders, such as photodermatoses, are caused by sun exposure. In addition cumulative sun exposure is directly related to different types of skin cancer, including malignant melanoma, basal, and squamous cell carcinomas (Thomas et al., 2011).
Wudu is observed as the following: washing of the hands three times alternately, rinsing out the mouth three times, rinsing out the nose three times by inhaling water into it and blowing it out, washing the whole face three times from ear to ear and from forehead to chin, washing the forearms from fingertip to elbow three times, wiping the head with wet hands from front to back and back to front (once), wiping the inside of the ears with wet forefingers and the back of the ear with thumbs (once), washing the feet three times up to the ankles. Muslims perform Wudu five times a day before each prayer (Al-Fawzan, 1988). 2.7. General cleanliness of the skin and contemporary medicine Performing ablution five times a day cleanses the nose of germs, dust and related contaminants. It is estimated that 500–1000 species of bacteria live on the skin (Grice et al., 2009). By performing Wudu, potentially pathogenic germs on the skin can be washed away.
2.3. Protection of the skin and Islam 3. The bath (ritual) in Islam Skin diseases are known to disseminate faster and more effectively in congested public areas. Prophet Muhammad (pbuh) stated, ‘‘When one of you discharges his phlegm in a mosque,
A full body wash is strongly recommended in many circumstances, including for ritual occasions (weekly for Friday gath-
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4 ering prayer and at the two Eid festivals). It is obligatory after sexual intercourse and at the conclusion of menstruation and postnatal bleeding (Al-Bukhari, 1987a). From an Islamic perspective, cleanliness is so important that Muslims are required to not go longer than seven days without a bath, even if he is excused from going to Juma’h, or Friday Congregational prayer. As narrated by Abu Hurairah, the prophet (pbuh) said, ‘‘It is an obligation upon every Muslim to wash his body once every seven days’’ (Al-Bukhari, 1987b, c).
K.M. AlGhamdi et al. Hand hygiene is critical after using the toilet or disposing of human or animal feces, immediately after handling raw food (e.g., chicken, meat), and before preparing and handling food (Scott and Herbold, 2010). Hand washing should be carried out frequently throughout the day, as one may come into contact with many potentially harmful bacteria (Fischler et al., 2007). In 1861, Semmelweis was the first to demonstrate the role of hand hygiene in the prevention of person-to-person transmission of infection (Tan and Brown, 2006). 3.3.2. Foot hygiene
3.1. The bath and contemporary medicine Showering is part of a daily routine primarily to promote cleanliness and improve health. Advances in science and medicine in the 19th century emphasized the benefit of regular bathing on an individual’s health. In 11 studies reviewed by Keswick et al. (1997), antimicrobial soaps significantly reduced the rates of superficial cutaneous infections. Studies conducted between the 1960s and 1980s demonstrated that showering and bathing increases the dispersal of skin bacteria into the air and ambient environment (Speers et al., 1965; Hall et al., 1986; Hoborn, 1981).
Use of good hygiene practices helps to prevent ailments of the foot and toenails. Athlete’s foot and fungal nail infections are very common and can be easily avoided and treated by using common sense and good cleansing routines (Gulcan et al., 2011). Ingrown toenails can be avoided by making sure the nails are trimmed correctly. If not properly cared for, ingrown toenails may lead to infection and pain (Heidelbaugh and Lee, 2009). Cracked heels, corns and calluses can also be prevented if hard skin is kept under control. In susceptible individuals, such as those with diabetes, proper foot hygiene can save the feet and legs from repeated infections that may lead to gangrene and amputation (Frykberg et al., 2000).
3.2. Hand and foot hygiene and Islam
3.4. Oral hygiene and Islam
In Wudu, hands and feet are washed five times a day, which reflects the importance of clean hands and feet in Islam. Whether washing with water alone or with other materials, Muslims are taught not to use the right hand to clean genitalia after urinating or defecating. In a narration by Abu Qatada, the Prophet (pbuh) said, ‘‘when anyone of you urinates, he should not hold his penis with his right hand, nor should he use his right hand in washing’’ (Al-Bukhari, 1987a). In Islam, the right hand is always given preference over the left hand. Muslims are required to use the right hand in all practices involving cleanliness, such as eating, drinking, and shaking hands. This preference is based on a narration by Aisha that states that the Prophet (pbuh) preferred the right side of the body in most of his practices, including eating, drinking, putting on shoes, and performing Wudu (Al-Bukhari, 1987b). Designating the left hand for dirty tasks such as cleaning the toilet and reserving the right hand for clean acts minimizes the use of same hand for both clean and unclean acts. This was particularly significant in previous eras in which there was no soap. The Prophet (pbuh) urged hand washing when waking up and prior to placing hands into a water vessel by stating, ‘‘when anyone of you wakes up after sleep, he should not insert his hand into the water vessel until he washes it (his hand) thrice, for he does not know where his hand was during the night’’ (Al-Naysaburi, 1972).
There are many Islamic practices involving oral hygiene. Rinsing the mouth is an integral part of Wudu and is recommended to be repeated two or three times. Rinsing the mouth is also recommended after consuming food or drink that contains fats. Islam stresses the use of Siwak (a traditional chewing stick used to clean the teeth), for cleaning the surface of and between the teeth. There are many hadiths about the protection and cleanliness of the mouth, and the most prominent are the following: All the hadiths and traditions of Wudu can be taken as guidance for cleaning the mouth. One of these hadiths was narrated by Humran, the servant of Othman, the third caliph, on how to perform Wudu. Humran said, ‘‘Othman ibn Affan asked for water, when he was brought it, he began his Wudu, then he rinsed his mouth and nose’’ (Al-Bukhari, 1987a). Abdullah ibn Zaid was asked to show how the Prophet (pbuh) did Wudu and said, ‘‘He began Wudu . . . then he rinsed his mouth and nose together with one handful of water. He did that three times’’ (Al-Bukhari, 1987b). Rinse the mouth after consuming food or drink. Swaid ibn al-Nu‘man narrated that the Prophet asked for food but there was nothing except Sawiq (cereal). He ate some and the people with him ate, and then he got up and washed his mouth and the people with him did so, then he led sunset prayer without Wudu (Al-Nasaai, 1986). The Prophet (pbuh) rinsed his mouth after drinking milk. It is narrated by ibn Abbas that the Prophet (pbuh) rinsed his mouth after drinking milk and said,’’ . . . it has fat in it’’ (Al-Bukhari, 1987a). Cleaning the mouth using Siwak. Siwak cleanses the mouth of food residue that can cause bad breath. There are many hadiths recommending the use of Siwak. Abu Hurairah narrated that the Prophet (pbuh) said, ‘‘If I had not found it hard for my followers, I would have ordered them to clean their teeth with Siwak for every prayer’’ (Al-Bukhari, 1987b). Aisha narrated that the Prophet (pbuh) also said, ‘‘Siwak is purification
3.3. Hand and feet hygiene in contemporary medicine 3.3.1. Hand hygiene Skin hygiene, particularly of the hands, is considered to be a primary mechanism for reducing the risk of transmission of infectious agents and prevents spreading of infectious diseases in the home and everyday life settings (Bloomfield et al., 2007).
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Skin care: Historical and contemporary views for the mouth and a way of seeking Allah’s pleasure’’ (AlAlbani, 1985). Similar to Siwak, a toothbrush can be used to clean the mouth. However, using Siwak is an act of obedience to Allah and is a way to seek his pleasure and receive his rewards as indicated by the hadiths and by Muslim scholars (Al-Nasaai, 1986). Tooth Picking. Tooth picking is one of the ways recommended by the Prophet to keep the mouth clean. Abu Huraira narrated that the Prophet (pbuh) said, ‘‘when you eat, you should throw out what sticks between the teeth and eat only what you chewed. Who does that will have done well’’ (Majah, 1975). 3.5. Oral hygiene in contemporary medicine The oral cavity is intensely colonized by bacteria, and can be inhabited by large numbers of certain fungi and primary parasites. The human mouth provides a suitable habitat for numerous bacterial genera and harbors more than 300 different bacterial species. The concentrations of bacteria in saliva range from 108 to 109 colony forming units/ml, and anaerobic bacteria outnumber aerobic bacteria by 10:1. All of these germs get their growth nutrients from food residues in the mouth. As they grow and flourish, the bacteria produce secretions that can affect the mouth, change its smell, and change the color and function of the teeth. Rinsing the mouth reduces those germs (Tschamer, 1973, March 10). Constant oral hygiene is of crucial importance for maintaining a healthy periodontium and to prevent the development of caries (Maltz et al., 2010). Oral hygiene is related to the number of bacterial species present in the mouth (Kazor et al., 2003). The Siwak, is a chewing stick, made from the plant Salvadora persica. For religious and cultural reasons, use of miswak is firmly established and widespread in Saudi Arabia and most other Muslim countries. Scientific evaluation of the miswak has been undertaken in recent years (Al-Otaibi et al., 2004). A study showed that, in contrast to toothbrush use, use of miswak significantly reduced the amount of Actinomycetem comitans in subgingival plaque (Sofrata et al., 2008). A few recent studies have identified active antimicrobial compounds (Wu et al., 2001). Today, chewing sticks are still used in many developing countries because of religion, tradition, availability, low cost and simplicity. The World Health Organization encourages their use. The Consensus Report on Oral Hygiene in the year 2000 states that chewing sticks may play a role in the promotion of oral hygiene and oral cancer prevention (Wu et al., 2001).
5 The Prophet (pbuh) also approved of rinsing water into the nose after waking up. Abu Hurairah narrated that the Prophet (pbuh) said, ‘‘when anyone of you wakes up after sleep, he should rinse his nose three times’’ (Al-Bukhari, 1987). 3.7. Nasal care in contemporary medicine Nasal care is important in modern medicine as well. Cleansing practices can prevent infection with Staphylococcus aureus which can have severe consequences. The anterior nares are reservoirs for S. aureus. Mucin appears to be the critical surface that is colonized in a process involving interactions between staphylococcal proteins and mucin carbohydrates (Shuter et al., 1996). Several studies have shown that elimination of nasal carriage reduced the incidence of S. aureus infections (Chow and Yu, 1989; Chatterjee et al., 2009). Cleaning the nose during Wudu (ablution) can clear the nose of S. aureus (Memish et al., 2006). 4. Hair care in Islam Cleaning body hair and removing all dust and dirt is emphasized in the prophetic tradition. The Prophet (pbuh) ordered that the hair on the head to be washed from the root three times in the ritual bath and wiped at every Wudu. Jubair ibn al-Mut‘am narrated that the Prophet (pbuh) said, ‘‘I pour three handfuls of water over my head, and he pointed to his hands’’ (Al-Bukhari, 1987). As narrated by Abu Hurrairah, the Prophet (pbuh) said, ‘‘those who have hair should honor it’’ (Al-Albani, 1985). Honoring the hair includes cleaning, combing and perfuming it. In this regard, Aishah asserted that she used to apply the best available perfume on the Prophet (pbuh) until she could see it sparkle in the hair of his head and beard (Al-Bukhari, 1987). The Prophet (pbuh) recommended growing the beard according to the narration of Omar, saying, ‘‘trim closely the moustache and let the beard grow’’ (Al-Naysaburi, 1972). With regard to facial hair, the Prophet (pbuh) ordered men not to leave a mustache untrimmed for more than forty days. Abu Huraira narrated that the Prophet (pbuh) said, ‘‘Five are the acts akin to Fitra (i.e., customs of sound nature): circumcision, shaving the pubic hair, cutting the nails, plucking the hair under the armpits and clipping the moustache’’ (Al-Bukhari, 1987). The Prophet (pbuh) ordered the removal of armpit hair and pubic hairs to be shaved (Al-Bukhari, 1987). Anas explained that the maximum time limit given for trimming the moustache, epilating armpit hair, and shaving pubic hair was every 40 days (Al-Naysaburi, 1972).
3.6. Nasal hygiene in Islam 4.1. Hair care in contemporary medicine Rinsing the nose is an important part of Wudu. Luqait ibn Saborah asked the Prophet to tell him about Wudu, and the Prophet (pbuh) replied, ‘‘Perform Wudu properly and thoroughly, wash between the fingers, and exaggerate in inhaling the water into the nose unless you are fasting’’ (Al-Tirmithi, 1983). In addition to inhaling water, the Prophet (pbuh) recommended rinsing water into the nose and blowing it out by saying, ‘‘rinse water into the nose and blow it out. Do that two or three times exaggeratedly’’ (Hajar, xxxx).
4.1.1. Cleaning body hair Pubic and axillary areas with sweat glands are prone to develop bad odor and infections if not properly cleaned (Leyden et al., 1981). They harbor many bacteria that can become pathogenic if immunity declines. Shaving axillary hair in men and women is recommended, but is an absolute necessity for all patients with apocrine bromhidrosis (malodorous body scent) to prevent the accumulation of sweat and bacteria on the hair shafts. Inadequate hygiene and medical or dermatologic
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6 conditions associated with hyperhidrosis may contribute to overgrowth of bacteria (Leyden et al., 1981). Trichomycosis is a bacterial infection of the hair shaft found in areas with sweat glands and has been described most commonly in the axillary region. A series of studies described trichomycosis in the inguinal area and have suggested that prevalence of this disease is underestimated in the general population. Its recurrence can be prevented by shaving pubic and axillary hairs and proper hygiene (Levit, 1990; White and Smith, 1979). Pubic lice can also be prevented by shaving the hair in the affected areas to ensure full removal of the dead lice and nits. Proper hair care can prevent diseases such as head lice (Drutz, 2004).
K.M. AlGhamdi et al. in cleaning the private part and not use less than three stones in cleaning and not to use dung or bones for cleaning’’ (Al-Naysaburi, 1972). 6.3. Genital hygiene in contemporary medicine
In Islam, it is recommended that nails are cut regularly. It is one of the acts akin to fitra (Al-Bukhari, 1987). Anas explained that the maximum time limit given for cutting nails was every 40 days’’ (Al-Naysaburi, 1972).
Women with recurrent urinary tract infections have an increased susceptibility to vaginal colonization with uropathogens (Hooton, 2001). Washing and bathing are the most important ways of maintaining good health and protecting the body from infections, illnesses and ailments. It is important to regularly wash the genital area, including the anus, to help ward off infections and bad odor. Because the genital area is moist and warm, bacteria can grow easily. Excretions from the vagina, perspiration, and urine can build up and make it even easier for bacteria to grow. These bacteria can cause urinary tract infections (UTIs) or vaginal infections. Cleaning the genital area with a mild soap and water on a regular basis controls bacterial growth and limits infections such as trichomoniasis, yeast infection, and gardnerella (Amiri et al., 2009).
5.1. Nail care in contemporary medicine
6.4. Genital hygiene in men
Onycholysis is a common disorder often caused by trauma to long fingernails (Daniel, 1991). Keeping nails short is a healthy practice that can prevent many diseases such as traumatic onycholysis and transmission of threadworm infestations (Harcup, 1995). Scratching the skin with long nails due to itchy skin conditions, such as eczema and atopic dermatitis, can aggravate the condition and result in dyspigmentation and scarring (Ruiz-Maldonado and OrozcoCovarrubias, 1997).
Genital hygiene in men includes washing the penis, scrotum and testicles, anus, and pubic hair with water and mild soap, as genital microbial pathogens can be carried on the skin of male genitals (Steele et al., 2004). Washing the anal area after defecation is a treatment for pruritus ani. Although an individual may not be aware of occult soiling, it can become itchy and lead to scratching (Siddiqi et al., 2008 Sep).
5. Nail care in Islam
7. Circumcision in Islam 6. Genital hygiene and Islam 6.1. Washing with water The private parts should be washed with water after urinating or defecating. Anas narrated, ‘‘Once, the Prophet (pbuh) came to us after relieving himself and washing himself with water’’ (Al-Bukhari, 1987a). In another narration he stated, ‘‘Whenever the Prophet (pbuh) went to relieve himself, I used to bring water with which he used to wash his private parts’’ (Al-Bukhari, 1987b). 6.2. Istejmar Istejmar involves purifying the front and back of the private parts from urine or feces using stones or alternative material such as tissue paper. Cleaning with this method should be repeated at least three times. Use of impure substances, such as livestock waste (dung), bones, or edible items, is prohibited (Othaimeen, 2009). According to a narration by Salman, the Prophet (pbuh) disapproved of using less than three stones. Salman reported that someone addressed him saying, ‘‘Your Prophet taught you everything, even how to clean yourselves from excrement? He replied, yes, the Prophet taught us not to use the right hand
The Prophet (pbuh) ordered the males to undergo circumcision. Abu Huraira narrated that the Prophet (pbuh) said, ‘‘five are the acts akin to Fitra: circumcision, etc. . .’’ (Al-Bukhari, 1987). 7.1. Circumcision in contemporary medicine Dead skin and an oil-like substance can accumulate under the foreskin to form a substance called smegma. If smegma is not washed from underneath the foreskin, it can build up, harden and lead to infection and disease (Van Howe, 2009 August). Circumcised men are less likely to have symptomatic genital ulcer disease, (Hoborn, 1981) and a meta-analysis suggested that circumcision is associated with reduced rates of ulceration due to herpes virus, syphilis and other sexually transmitted infections (STIs) (Weiss et al., 2006). Reduced male carriage of these pathogens may lower the rates of transmission of these ulcerative STIs to women. The moist subpreputial space in uncircumcised men may enhance the survival of trichomonas and gram negative anaerobes associated with bacterial vaginosis. Removal of the foreskin could reduce female’s exposure to these pathogens (O’Farrell, 2006). Human immunodeficiency virus (HIV) prevalence is likely to be lower in circumcised male partners (Larke, 2010).
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Skin care: Historical and contemporary views In March 2007 the World Health Organization (WHO) and the United Nations Joint Programme on AIDS (UNAIDS) recommended that male circumcision should be considered as part of a comprehensive HIV prevention package (WHO, 2007). 8. Conclusion Skin care is an essential part of personal hygiene and well being. Islam has always placed a strong emphasis on hygiene. In addition to the need to be ritually clean at the time of the daily prayer through ablution and ritual bath, there are a large number of other hygiene-related rules governing the lives of Muslims. In general, the Qur’an advises Muslims to uphold high standards of physical hygiene and to be ritually clean whenever possible. The proper care of skin and related appendages and orifices is important in contemporary medicine because unclean skin favors the development of pathogenic organisms and infections. References Al-Albani, Muhammad, 1985. Irwa’ al-Ghaleel fi Takhreej Ahaadith Manar al-Sabeel 1 (66), 105. Al-Albani, Muhammad, 1985. Al-Selselah al-Saheehah. al-Maktabah al-Islamiyyah, Beirut, 1, 899. Al-Albani, Muhammad, 1987. Sahih. Dar al-Qalam, Beirut, no. 899. Al-Albani, Muhammad, 1987. Sahih. Dar al-Qalam, Beirut, no. 3295. Al-Albani, Muhammad, 1987. Sahih. Dar al-Qalam, Beirut, no. 254. Al-Albani, Muhammad, 1987. Sahih. Dar al-Qalam, Beirut, no. 5923. Al-Albani, Muhammad, 1987. Sahih. Dar al-Qalam, Beirut, no. 5889. Al-Albani, Muhammad, 1987a. Sahih. Dar al-Qalam, Beirut, no. 300. Al-Albani, Muhammad, 1987. Sahih. Dar al-Qalam, Beirut, 153–1545630. Al-Albani, Muhammad, 1987. Sahih. Dar al-Qalam, Beirut, no. 159. Al-Albani, Muhammad, 1987. Sahih. Dar al-Qalam, Beirut, no. 221– 5609. Al-Albani, Muhammad, 1987. Sahih. Dar al-Qalam, Beirut, no. 150, 151. Al-Albani, Muhammad, 1987. Sahih. Dar al-Qalam, Beirut, no. 848– 879-880. Al-Albani, Muhammad, 1987. Sahih. Dar al-Qalam, Beirut, no. 168. Al-Albani, Muhammad, 1987. Sahih. Dar al-Qalam, Beirut, no. 191. Al-Albani, Muhammad, 1987. Sahih. Dar al-Qalam, Beirut, no. 887. Al-Albani, Muhammad, 1987b. Sahih. Dar al-Qalam, Beirut, no. 217. Al-Albani, Muhammad, 1987. Sahih. Dar al-Qalam, Beirut, no. 897– 898. Al-Albani, Muhammad, 1988. Sahih. Dar al-Qalam, Beirut, 1, 46–47. Al-Mustadrak. Beirut: Dar al-Ma’rifah, vol. 4, p. 272 (n.d.) (1979). Al-Nasaai, Ahmad, 1986. Sunan. Dar al-‘Asha’ir, Damascus, 1, 108. Al-Nasaai, Ahmad, 1986. Sunan. Dar al-‘Asha’ir, Damascus, 5. Al-Naysaburi, Muslim, 1972. Sahih. Dar Ihia’ al-Turath, Beirut, no. 278. Al-Naysaburi, Muslim, 1972. Sahih. Dar Ihia’ al-Turath, Beirut, no. 259. Al-Naysaburi, Muslim, 1972. Sahih. Dar Ihia’ al-Turath, Beirut, no. 258. Al-Al-Naysaburi, Muslim, 1972. Sahih. Dar Ihia’ al-Turath, Beirut, no. 262. Al-Otaibi, M., Al-Harthy, M., Gustafsson, A., et al, 2004. Subgingival plaque microbiota in Saudi Arabians after use of miswak chewing stick and toothbrush. J. Clin. Periodontol. 31 (12), 1048–1053. Al-Tirmithi, Muhammad., 1983. Sunan. Beirut: Dar Al-Fikr, p. 778.
7 Amiri, F.N., Rooshan, M.H., Ahmady, M.H., et al, 2009. Hygiene practices and sexual activity associated with urinary tract infection in pregnant women. East. Mediterr. Health J. 15 (1), 104–110. Bloomfield, S.F., Aiello, A.E., Cookson, B., et al, 2007. The effectiveness of hand hygiene procedures including handwashing and alcohol-based hand sanitizers in reducing the risks of infections in home and community setting. Am. J. Infect. 35 (Suppl. 1), 1–64. Carlson, B.M., 1994. Integumentary, skeletal muscular systems. In Human Embryology and Developmental Biology. 153–181. Chatterjee, S.S., Ray, P., Aggarwal, A., et al, 2009. A communitybased study on nasal carriage of Staphylococcus aureus. Indian J. Med. Res. 130 (6), 742–748. Chow, J.W., Yu, V.L., 1989. Staphylococcus aureus nasal carriage in hemodialysis patients: its role in infection and approaches to prophylaxis. Arch. Intern. Med. 149, 1258–1262. Daniel 3rd, C.R., 1991. Onycholysis: an overview. Semin. Dermatol. 10, 34–40. Drutz, J.E. (Ed.), 2004. Arthropods, 5th ed.Feigin, R.D. et al. (Eds.). Textbook of Pediatric Infectious Diseases, Vol. 2 Springer, Berlin, pp. 2835–2840. Ekanem, E.E., Akitoye, C.O., Adedeji, O.T., 1991. Food hygiene behaviour and childhood diarrhoea in Lagos, Nigeria: a casecontrol study. J. Diarrhoeal. Dis. Res. 9, 219–226. Fischler, G.E., Fuls, J.L., Dail, E.W., et al, 2007. Effect of hand wash agents on controlling the transmission of pathogenic bacteria from hands to food. J. Food Prot. 70 (12), 2873–2877. Frykberg, R.G., Armstrong, D.G., Giurini, J., et al, 2000. Diabetic foot disorders. A clinical practice guideline. For the American College of Foot and Ankle Surgeons and the American College of Foot and Ankle Orthopedics and Medicine. J. Foot Ankle Surg. 63 (Suppl. 1), 1–60. Grice, E.A., Kong, H.H., Conlan, S., 2009. Topographical and temporal diversity of the human skin microbiome. Science 324, 1190–1192. Green, V.W., 1984. Cleanliness and the health revolution. New York: Soap and Detergent Association. Available from: . Gulcan, A., Gulcan, E., Oksuz, S., et al, 2011. Prevalence of toenail onychomycosis in patients with type 2 diabetes mellitus and evaluation of risk factors. J. Am. Podiatr. Med. Assoc. 101 (1), 49– 54. Ibn Hajar, Ahmad al-‘Asqalani. Fath{ al-Bari bi Sharh Sahih alBukhari. Cairo: al-Matba‘a al-Salafiyya, vol. 1, p. 610 (1988). Ibn Hajar, Ahmad al-‘Asqalani. Al-Talkhees al-Habeer. Cairo: Maktabat Ibn Taimiyyah, vol. 1, p. 82 (n.d.) (1966). Hall, G.S., Mackintosh, C.A., Hoffman, P.N., 1986. The dispersal of bacteria and skin scales from the body after showering and after application of a skin lotion. J. Hyg. (Lond) 97, 289–298. Ibn Hanbal, Ahmad. Musnad. Cairo: Dar al-Ma‘arif, vol. 4, p. 39 (1986). Harcup, J., 1995. Tackling threadworms. Prof. Care Mother Child. 5 (1), 15–16. World Health Organization., 2005. WHO Global Influenza Preparedness Plan. The Role of WHO and Recommendations for National Measures Before and During Pandemics. Geneva: World Health Organization. Available at: . Heidelbaugh, J.J., Lee, H., 2009. Management of the ingrown toenail. Am. Fam. Physician 79 (4), 303–308. Hoborn, J., 1981. Humans as Dispersers of Microorganisms––Dispersion Pattern and Prevention [dissertation]. University of Goteborg, Goteborg, Sweden, 1–128. Hooton, T.M., 2001. Recurrent urinary tract infection in women. Int. J. Antimicrob. Agents 17 (4), 259–268. Kazor, C.E., Mitchell, P.M., Lee, A.M., et al, 2003. Diversity of bacterial populations on the tongue dorsa of patients with halitosis and healthy patients. J. Clin. Microbiol. 41 (2), 558–563.
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8 Keswick, B.H., Berge, C.A., Bartolo, R.G., et al, 1997. Antimicrobial soaps: their role in personal hygiene. In: Aly, R., Beutner, K.R., Maibach, H. (Eds.), Cutaneous Infection and Therapy. Marcel Dekker, New York, pp. 49–82. Kochevar, I.E., Taylor, C.R., Krutmann, J., 2008. Fundamentals of cutaneous photobiology and photoimmunology. In: Wolff, K., Goldsmith, L.A., Katz, S., et al. (Eds.), Fitzpatrick’s Dermatology in General Medicine, 7th ed. McGraw-Hill, New York, pp. 797– 808. Krutmann, J., Gilchrest, B.A., 2006. Photoaging of skin. In: Gilchrest, Barbara A., Krutmann, Jean. (Eds.), Skin Aging, 1st ed. Springer, New York, pp. 33–44. Kullavanijaya, P., Lim, H.W., 2005. Photoprotection. J. Am. Acad. Dermatol. 52, 937–958. Larke, N., 2010. Male circumcision, HIV and sexually transmitted infections: a review. Br. J. Nurs. 19 (10), 629–634. Larson, E., 1997. Social and economic impact of infectious diseases– United States. Clin Perform. Qual. Health Care 5, 31–37. Larson, E., 1999. Skin hygiene and infection prevention: more of the same or different approaches? Clin. Infect. Dis. 29 (5), 1287–1294. Levit, F., 1990. Trichomycosis axillaris. J. Am. Acad. Dermatol. 22 (5 Pt 1), 858–859. Leyden, J.J., McGinley, K.J., Ho¨lzle, E., et al, 1981. The microbiology of the human axilla and its relationship to axillary odor. J. Invest. Dermatol. 77 (5), 413–416. Ibn Majah, Muhammad. Sunan. Beirut: Dar Ihya’ al-Turath, p. 337 (1975). Maltz, M., Jardim, J.J., Alves, L.S., 2010. Health promotion and dental caries. Braz. Oral Res. 24 (Suppl. 1), 18–25. Memish, Z.A., Balkhy, H.H., Almuneef, M.A., et al, 2006. Carriage of Staphylococcus aureus among Hajj pilgrims. Saudi Med. J. 27 (9), 1367–1372. Noble, W.C., Davies, R.R., 1965. Studies on the dispersal of staphylococci. J. Clin. Pathol. 18, 16–20. O’Farrell, Morison L., Moodley, P., et al, 2006. Association between HIV and subpreputial penile wetness in uncircumcised men in South Africa. JAIDS 43, 69. Ibn Othaimeen, Muhammad. I‘laam al-Musafereen. Onaizah: Muhammad Ibn Othaimeen Est. p. 15 (2009). Proksch, E., Brandner, J.M., Jensen, J.M., 2008. The skin: an indispensable barrier. Exp. Dermatol. 17 (12), 1063–1072. Ruiz-Maldonado, Orozco-Covarrubias, M.L., 1997. Post inflammatory hypopigmentation and hyperpigmentation. Semin. Cutan. Med. Surg. 1997 (16), 36–43. Scott, E., Herbold, N., 2010. An in-home video study and questionnaire survey of food preparation, kitchen sanitation, and hand washing practices. J. Environ. Health. 72 (10), 8–13.
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King Saud University
Saudi Pharmaceutical Journal www.ksu.edu.sa www.sciencedirect.com
REVIEW
Skin care: Historical and contemporary views Khalid M. AlGhamdi
a,b,*
, Fahad A. AlHomoudi
c,d
, Huma Khurram
b
a
Dermatology Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia Vitiligo Research Chair, College of Medicine, King Saud University, Riyadh, Saudi Arabia c Deanship of Academic Research, Imam University, Riyadh, Saudi Arabia d Princess Noura bint Abdulrahman University, Riyadh, Saudi Arabia b
Received 1 February 2013; accepted 26 February 2013
KEYWORDS Health; Skin hygiene; Skin care; Islam
Abstract Primary prevention, specifically skin care, is an important principle in Islamic theology just as it is emphasized in contemporary medicine. Many skin diseases can be prevented by a proactive approach to skin care, such as proper hygiene and routine inspections, principles that are constantly highlighted in the Islamic literature. Islam promotes primary prevention of disease, including recommendations for skin care practices. The recommendations for skin care practices in Islamic teachings are analogous to current medical guidelines. Sun avoidance, which is recommended by Islam, is mandatory for diseases such as systemic lupus erythematosus, melasma and skin cancers. Skin care and hygiene practices are recommended in Islam and it is considered an important mechanism for reducing the transmission of infections in modern medicine. The body creases and hair are ideal sites for malicious infestations to grow. The practice of ‘‘Wudu’’ includes washing the hands, feet, and hair with clean water. It is an indispensible part of daily prayers which is mandatory for every Muslim. Oral hygiene is also an integral part of both preventive medicine and Islamic teachings. Genital hygiene, particularly after urination and defecation, is recommended in Islamic teachings and is known to prevent urinary and vaginal infections in contemporary medicine. Male circumcision is an Islamic practice. Recently, it was proven that circumcised men are less likely to have sexually transmitted diseases, including HIV. This paper reviews skin care from an Islamic perspective and its relevance to contemporary medicine by translating the simple self care principles into practical guidelines in everyday use. ª 2013 Production and hosting by Elsevier B.V. on behalf of King Saud University.
* Corresponding author. Address: Dermatology Department Director, Vitiligo Research Chair College of Medicine, King Saud University P.O. Box 240997, Riyadh 11322, Saudi Arabia. E-mail address: [email protected] (K.M. AlGhamdi). Peer review under responsibility of King Saud University.
Production and hosting by Elsevier 1319-0164 ª 2013 Production and hosting by Elsevier B.V. on behalf of King Saud University. http://dx.doi.org/10.1016/j.jsps.2013.02.005
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2
K.M. AlGhamdi et al.
Contents 1. 2.
3.
4.
5. 6.
7. 8.
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Skin care and protection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.1. Sun avoidance and Islam. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.2. Sun avoidance and contemporary medicine. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.3. Protection of the skin and Islam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.4. Protection of the skin and contemporary medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.5. General cleanliness of the skin and Islam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.6. Wudu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2.7. General cleanliness of the skin and contemporary medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . The bath (ritual) in Islam. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.1. The bath and contemporary medicine. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.2. Hand and foot hygiene and Islam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.3. Hand and feet hygiene in contemporary medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.3.1. Hand hygiene . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.3.2. Foot hygiene . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.4. Oral hygiene and Islam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.5. Oral hygiene in contemporary medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.6. Nasal hygiene in Islam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.7. Nasal care in contemporary medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Hair care in Islam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.1. Hair care in contemporary medicine. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.1.1. Cleaning body hair . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Nail care in Islam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.1. Nail care in contemporary medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Genital hygiene and Islam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.1. Washing with water . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.2. Istejmar . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.3. Genital hygiene in contemporary medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.4. Genital hygiene in men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Circumcision in Islam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.1. Circumcision in contemporary medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1. Introduction The skin is the largest organ of the body and consists of epidermis, dermis and appendages such as hair, nails and sebaceous and sweat glands (Carlson, 1994). The stratum corneum, the outermost layer of the skin, is composed of dead and flattened cells (corneocytes) that form a tough, horny layer of keratin mixed with lipids, which maintains hydration, pliability, and the effective barrier of the skin (Wysocki, 1999). Approximately 10 (Krutmann and Gilchrest, 2006) particles are disseminated from the healthy skin into air each day, and 10% of these skin squames contain viable bacteria (Noble and Davies, 1965). Due to constant interaction with the surrounding environment, skin plays a key role in protecting the body against pathogens (Proksch et al., 2008). Hygiene is more than just being clean. It comprises several practices that help people achieve and maintain a healthy life. Personal hygiene not only prevents several infections from spreading but also improves individuals’ self-esteem and contributes to mental well-being. A glance into the history of medicine will clearly reveal that infections have always been a significant source of morbidity and mortality. The contagious nature of certain illnesses is well
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documented, and basic control measures are usually required to combat spread of infections in a community Larson (1999)). Advances in medicine eventually led to the identification of specific disease-producing organisms and mechanisms favorable for disease transmission, which enabled the development of effective measures to prevent or control the spread of communicable diseases. Islamic teachings reveal that skin care and hygiene is integral to the religion, as indicated from the words in the Holy Quran: ‘‘Indeed, Allah loves those who are constantly repentant and loves those who purify themselves.’’ (Holy Quran, 2: p. 222). In this review, we explored Islamic recommendations for skin and related appendages, including hair, nails and mucous membranes, (Table 1) and corroborate their importance in contemporary practice of medicine. 2. Skin care and protection Skin protection has been directly addressed in the sermons by Prophet Muhammad, peace be upon him (pbuh), recommended protecting and taking care of the skin. Below are examples from hadith (Prophet’s sayings) regarding skin protection.
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Skin care: Historical and contemporary views Table 1 Components of skin care in Islam and contemporary medicine. A. B. C.
D.
E. F. G.
H.
Skin care and protection 1.Sun avoidance Protecting the skin from all impurities General cleanliness of the skin 1.Wudu 2.Bath and shower Taking care of hands and feet 1.Hand hygiene 2.Foot hygiene Keeping a healthy mouth Cleaning the nose Care of hair and nails 1.Shaving hair 2.Nail care Keeping the genital area clean 1.Washing 2.Circumcision
3 he should clean it away in case it sticks to the skin or the cloth of another person and so harms him’’ (Hajar, 1988). 2.4. Protection of the skin and contemporary medicine Transmission of infections can be prevented and controlled through the application of basic infection control precautions that can be grouped into general and transmission-specific (e.g., airborne, droplet and contact) (Green, 1984; Larson, 1997; Ekanem et al., 1991). Many diseases are transmitted by droplet and air route, including pneumonia, pertussis, diphtheria, influenza type B, mumps, and meningitis (Larson, 1997). Droplet transmission occurs when there is adequate contact between large particle droplets (>5 microns) and the mucous membranes of the nose and mouth or conjunctivae of a susceptible person (Hea, 2005). Droplets are usually generated from an infected person as a result of coughing, sneezing or talking (Xie et al., 2009). 2.5. General cleanliness of the skin and Islam
2.1. Sun avoidance and Islam One way of protecting the skin is to avoid exposure to the sun. Skin should be protected from all impurities and dirty things. Examples from the hadith (Prophet’s sayings) are shown to describe how the Prophet (pbuh) regarded skin protection. Prophet Muhammad (pbuh) advised his followers to avoid long exposure to the sun. In his book, Abu Dawod included the narration of Abu Hazim, who reported that while the Prophet (pbuh) was giving a speech, he came and sat in the sun, whereupon the Prophet (pbuh) ordered him to move, and he sat in the shade (Al-Mustadrak, xxxx).
The Prophet’s (pbuh) concern with bodily cleanliness is demonstrated from his emphasis on the ritual bath (required after engaging in sexual intercourse and at the conclusion of menstruation) (Al-Bukhari, 1987) and Wudu. Wudu (Muslims’ ablution), has specific acts including washing the exposed body parts as well as the areas between the fingers and toes with clean water. It has been said that the Prophet (pbuh) observed Wudu by washing his hands and face only once, although sometimes he washed them two or three times. According to Abdullah ibn Zaid, ‘‘The prophet was given water that fills his palm, and he rubbed out his forearms’’ (Hanbal, 1986).
2.2. Sun avoidance and contemporary medicine
2.6. Wudu
Moderate sunlight exposure has several health benefits in infants and adults. However, prolonged, direct, and unprotected sun exposure can have detrimental effects, including premature aging of the skin and the development and progression of skin cancer (Krutmann and Gilchrest, 2006; Kochevar et al., 2008). It is well known that the most effective protection against Ultraviolet (UV) radiation is sun avoidance. Limiting exposure or minimizing direct exposure during peak times and wearing appropriate clothing are also recommended (Kullavanijaya and Lim, 2005). Many dermatological diseases, including cutaneous lupus erythematosus, xeroderma pigmentosa, and dermatomyositis, are known to be aggravated by sun exposure (Yashar and Lim, 2003). Some disorders, such as photodermatoses, are caused by sun exposure. In addition cumulative sun exposure is directly related to different types of skin cancer, including malignant melanoma, basal, and squamous cell carcinomas (Thomas et al., 2011).
Wudu is observed as the following: washing of the hands three times alternately, rinsing out the mouth three times, rinsing out the nose three times by inhaling water into it and blowing it out, washing the whole face three times from ear to ear and from forehead to chin, washing the forearms from fingertip to elbow three times, wiping the head with wet hands from front to back and back to front (once), wiping the inside of the ears with wet forefingers and the back of the ear with thumbs (once), washing the feet three times up to the ankles. Muslims perform Wudu five times a day before each prayer (Al-Fawzan, 1988). 2.7. General cleanliness of the skin and contemporary medicine Performing ablution five times a day cleanses the nose of germs, dust and related contaminants. It is estimated that 500–1000 species of bacteria live on the skin (Grice et al., 2009). By performing Wudu, potentially pathogenic germs on the skin can be washed away.
2.3. Protection of the skin and Islam 3. The bath (ritual) in Islam Skin diseases are known to disseminate faster and more effectively in congested public areas. Prophet Muhammad (pbuh) stated, ‘‘When one of you discharges his phlegm in a mosque,
A full body wash is strongly recommended in many circumstances, including for ritual occasions (weekly for Friday gath-
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4 ering prayer and at the two Eid festivals). It is obligatory after sexual intercourse and at the conclusion of menstruation and postnatal bleeding (Al-Bukhari, 1987a). From an Islamic perspective, cleanliness is so important that Muslims are required to not go longer than seven days without a bath, even if he is excused from going to Juma’h, or Friday Congregational prayer. As narrated by Abu Hurairah, the prophet (pbuh) said, ‘‘It is an obligation upon every Muslim to wash his body once every seven days’’ (Al-Bukhari, 1987b, c).
K.M. AlGhamdi et al. Hand hygiene is critical after using the toilet or disposing of human or animal feces, immediately after handling raw food (e.g., chicken, meat), and before preparing and handling food (Scott and Herbold, 2010). Hand washing should be carried out frequently throughout the day, as one may come into contact with many potentially harmful bacteria (Fischler et al., 2007). In 1861, Semmelweis was the first to demonstrate the role of hand hygiene in the prevention of person-to-person transmission of infection (Tan and Brown, 2006). 3.3.2. Foot hygiene
3.1. The bath and contemporary medicine Showering is part of a daily routine primarily to promote cleanliness and improve health. Advances in science and medicine in the 19th century emphasized the benefit of regular bathing on an individual’s health. In 11 studies reviewed by Keswick et al. (1997), antimicrobial soaps significantly reduced the rates of superficial cutaneous infections. Studies conducted between the 1960s and 1980s demonstrated that showering and bathing increases the dispersal of skin bacteria into the air and ambient environment (Speers et al., 1965; Hall et al., 1986; Hoborn, 1981).
Use of good hygiene practices helps to prevent ailments of the foot and toenails. Athlete’s foot and fungal nail infections are very common and can be easily avoided and treated by using common sense and good cleansing routines (Gulcan et al., 2011). Ingrown toenails can be avoided by making sure the nails are trimmed correctly. If not properly cared for, ingrown toenails may lead to infection and pain (Heidelbaugh and Lee, 2009). Cracked heels, corns and calluses can also be prevented if hard skin is kept under control. In susceptible individuals, such as those with diabetes, proper foot hygiene can save the feet and legs from repeated infections that may lead to gangrene and amputation (Frykberg et al., 2000).
3.2. Hand and foot hygiene and Islam
3.4. Oral hygiene and Islam
In Wudu, hands and feet are washed five times a day, which reflects the importance of clean hands and feet in Islam. Whether washing with water alone or with other materials, Muslims are taught not to use the right hand to clean genitalia after urinating or defecating. In a narration by Abu Qatada, the Prophet (pbuh) said, ‘‘when anyone of you urinates, he should not hold his penis with his right hand, nor should he use his right hand in washing’’ (Al-Bukhari, 1987a). In Islam, the right hand is always given preference over the left hand. Muslims are required to use the right hand in all practices involving cleanliness, such as eating, drinking, and shaking hands. This preference is based on a narration by Aisha that states that the Prophet (pbuh) preferred the right side of the body in most of his practices, including eating, drinking, putting on shoes, and performing Wudu (Al-Bukhari, 1987b). Designating the left hand for dirty tasks such as cleaning the toilet and reserving the right hand for clean acts minimizes the use of same hand for both clean and unclean acts. This was particularly significant in previous eras in which there was no soap. The Prophet (pbuh) urged hand washing when waking up and prior to placing hands into a water vessel by stating, ‘‘when anyone of you wakes up after sleep, he should not insert his hand into the water vessel until he washes it (his hand) thrice, for he does not know where his hand was during the night’’ (Al-Naysaburi, 1972).
There are many Islamic practices involving oral hygiene. Rinsing the mouth is an integral part of Wudu and is recommended to be repeated two or three times. Rinsing the mouth is also recommended after consuming food or drink that contains fats. Islam stresses the use of Siwak (a traditional chewing stick used to clean the teeth), for cleaning the surface of and between the teeth. There are many hadiths about the protection and cleanliness of the mouth, and the most prominent are the following: All the hadiths and traditions of Wudu can be taken as guidance for cleaning the mouth. One of these hadiths was narrated by Humran, the servant of Othman, the third caliph, on how to perform Wudu. Humran said, ‘‘Othman ibn Affan asked for water, when he was brought it, he began his Wudu, then he rinsed his mouth and nose’’ (Al-Bukhari, 1987a). Abdullah ibn Zaid was asked to show how the Prophet (pbuh) did Wudu and said, ‘‘He began Wudu . . . then he rinsed his mouth and nose together with one handful of water. He did that three times’’ (Al-Bukhari, 1987b). Rinse the mouth after consuming food or drink. Swaid ibn al-Nu‘man narrated that the Prophet asked for food but there was nothing except Sawiq (cereal). He ate some and the people with him ate, and then he got up and washed his mouth and the people with him did so, then he led sunset prayer without Wudu (Al-Nasaai, 1986). The Prophet (pbuh) rinsed his mouth after drinking milk. It is narrated by ibn Abbas that the Prophet (pbuh) rinsed his mouth after drinking milk and said,’’ . . . it has fat in it’’ (Al-Bukhari, 1987a). Cleaning the mouth using Siwak. Siwak cleanses the mouth of food residue that can cause bad breath. There are many hadiths recommending the use of Siwak. Abu Hurairah narrated that the Prophet (pbuh) said, ‘‘If I had not found it hard for my followers, I would have ordered them to clean their teeth with Siwak for every prayer’’ (Al-Bukhari, 1987b). Aisha narrated that the Prophet (pbuh) also said, ‘‘Siwak is purification
3.3. Hand and feet hygiene in contemporary medicine 3.3.1. Hand hygiene Skin hygiene, particularly of the hands, is considered to be a primary mechanism for reducing the risk of transmission of infectious agents and prevents spreading of infectious diseases in the home and everyday life settings (Bloomfield et al., 2007).
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Skin care: Historical and contemporary views for the mouth and a way of seeking Allah’s pleasure’’ (AlAlbani, 1985). Similar to Siwak, a toothbrush can be used to clean the mouth. However, using Siwak is an act of obedience to Allah and is a way to seek his pleasure and receive his rewards as indicated by the hadiths and by Muslim scholars (Al-Nasaai, 1986). Tooth Picking. Tooth picking is one of the ways recommended by the Prophet to keep the mouth clean. Abu Huraira narrated that the Prophet (pbuh) said, ‘‘when you eat, you should throw out what sticks between the teeth and eat only what you chewed. Who does that will have done well’’ (Majah, 1975). 3.5. Oral hygiene in contemporary medicine The oral cavity is intensely colonized by bacteria, and can be inhabited by large numbers of certain fungi and primary parasites. The human mouth provides a suitable habitat for numerous bacterial genera and harbors more than 300 different bacterial species. The concentrations of bacteria in saliva range from 108 to 109 colony forming units/ml, and anaerobic bacteria outnumber aerobic bacteria by 10:1. All of these germs get their growth nutrients from food residues in the mouth. As they grow and flourish, the bacteria produce secretions that can affect the mouth, change its smell, and change the color and function of the teeth. Rinsing the mouth reduces those germs (Tschamer, 1973, March 10). Constant oral hygiene is of crucial importance for maintaining a healthy periodontium and to prevent the development of caries (Maltz et al., 2010). Oral hygiene is related to the number of bacterial species present in the mouth (Kazor et al., 2003). The Siwak, is a chewing stick, made from the plant Salvadora persica. For religious and cultural reasons, use of miswak is firmly established and widespread in Saudi Arabia and most other Muslim countries. Scientific evaluation of the miswak has been undertaken in recent years (Al-Otaibi et al., 2004). A study showed that, in contrast to toothbrush use, use of miswak significantly reduced the amount of Actinomycetem comitans in subgingival plaque (Sofrata et al., 2008). A few recent studies have identified active antimicrobial compounds (Wu et al., 2001). Today, chewing sticks are still used in many developing countries because of religion, tradition, availability, low cost and simplicity. The World Health Organization encourages their use. The Consensus Report on Oral Hygiene in the year 2000 states that chewing sticks may play a role in the promotion of oral hygiene and oral cancer prevention (Wu et al., 2001).
5 The Prophet (pbuh) also approved of rinsing water into the nose after waking up. Abu Hurairah narrated that the Prophet (pbuh) said, ‘‘when anyone of you wakes up after sleep, he should rinse his nose three times’’ (Al-Bukhari, 1987). 3.7. Nasal care in contemporary medicine Nasal care is important in modern medicine as well. Cleansing practices can prevent infection with Staphylococcus aureus which can have severe consequences. The anterior nares are reservoirs for S. aureus. Mucin appears to be the critical surface that is colonized in a process involving interactions between staphylococcal proteins and mucin carbohydrates (Shuter et al., 1996). Several studies have shown that elimination of nasal carriage reduced the incidence of S. aureus infections (Chow and Yu, 1989; Chatterjee et al., 2009). Cleaning the nose during Wudu (ablution) can clear the nose of S. aureus (Memish et al., 2006). 4. Hair care in Islam Cleaning body hair and removing all dust and dirt is emphasized in the prophetic tradition. The Prophet (pbuh) ordered that the hair on the head to be washed from the root three times in the ritual bath and wiped at every Wudu. Jubair ibn al-Mut‘am narrated that the Prophet (pbuh) said, ‘‘I pour three handfuls of water over my head, and he pointed to his hands’’ (Al-Bukhari, 1987). As narrated by Abu Hurrairah, the Prophet (pbuh) said, ‘‘those who have hair should honor it’’ (Al-Albani, 1985). Honoring the hair includes cleaning, combing and perfuming it. In this regard, Aishah asserted that she used to apply the best available perfume on the Prophet (pbuh) until she could see it sparkle in the hair of his head and beard (Al-Bukhari, 1987). The Prophet (pbuh) recommended growing the beard according to the narration of Omar, saying, ‘‘trim closely the moustache and let the beard grow’’ (Al-Naysaburi, 1972). With regard to facial hair, the Prophet (pbuh) ordered men not to leave a mustache untrimmed for more than forty days. Abu Huraira narrated that the Prophet (pbuh) said, ‘‘Five are the acts akin to Fitra (i.e., customs of sound nature): circumcision, shaving the pubic hair, cutting the nails, plucking the hair under the armpits and clipping the moustache’’ (Al-Bukhari, 1987). The Prophet (pbuh) ordered the removal of armpit hair and pubic hairs to be shaved (Al-Bukhari, 1987). Anas explained that the maximum time limit given for trimming the moustache, epilating armpit hair, and shaving pubic hair was every 40 days (Al-Naysaburi, 1972).
3.6. Nasal hygiene in Islam 4.1. Hair care in contemporary medicine Rinsing the nose is an important part of Wudu. Luqait ibn Saborah asked the Prophet to tell him about Wudu, and the Prophet (pbuh) replied, ‘‘Perform Wudu properly and thoroughly, wash between the fingers, and exaggerate in inhaling the water into the nose unless you are fasting’’ (Al-Tirmithi, 1983). In addition to inhaling water, the Prophet (pbuh) recommended rinsing water into the nose and blowing it out by saying, ‘‘rinse water into the nose and blow it out. Do that two or three times exaggeratedly’’ (Hajar, xxxx).
4.1.1. Cleaning body hair Pubic and axillary areas with sweat glands are prone to develop bad odor and infections if not properly cleaned (Leyden et al., 1981). They harbor many bacteria that can become pathogenic if immunity declines. Shaving axillary hair in men and women is recommended, but is an absolute necessity for all patients with apocrine bromhidrosis (malodorous body scent) to prevent the accumulation of sweat and bacteria on the hair shafts. Inadequate hygiene and medical or dermatologic
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6 conditions associated with hyperhidrosis may contribute to overgrowth of bacteria (Leyden et al., 1981). Trichomycosis is a bacterial infection of the hair shaft found in areas with sweat glands and has been described most commonly in the axillary region. A series of studies described trichomycosis in the inguinal area and have suggested that prevalence of this disease is underestimated in the general population. Its recurrence can be prevented by shaving pubic and axillary hairs and proper hygiene (Levit, 1990; White and Smith, 1979). Pubic lice can also be prevented by shaving the hair in the affected areas to ensure full removal of the dead lice and nits. Proper hair care can prevent diseases such as head lice (Drutz, 2004).
K.M. AlGhamdi et al. in cleaning the private part and not use less than three stones in cleaning and not to use dung or bones for cleaning’’ (Al-Naysaburi, 1972). 6.3. Genital hygiene in contemporary medicine
In Islam, it is recommended that nails are cut regularly. It is one of the acts akin to fitra (Al-Bukhari, 1987). Anas explained that the maximum time limit given for cutting nails was every 40 days’’ (Al-Naysaburi, 1972).
Women with recurrent urinary tract infections have an increased susceptibility to vaginal colonization with uropathogens (Hooton, 2001). Washing and bathing are the most important ways of maintaining good health and protecting the body from infections, illnesses and ailments. It is important to regularly wash the genital area, including the anus, to help ward off infections and bad odor. Because the genital area is moist and warm, bacteria can grow easily. Excretions from the vagina, perspiration, and urine can build up and make it even easier for bacteria to grow. These bacteria can cause urinary tract infections (UTIs) or vaginal infections. Cleaning the genital area with a mild soap and water on a regular basis controls bacterial growth and limits infections such as trichomoniasis, yeast infection, and gardnerella (Amiri et al., 2009).
5.1. Nail care in contemporary medicine
6.4. Genital hygiene in men
Onycholysis is a common disorder often caused by trauma to long fingernails (Daniel, 1991). Keeping nails short is a healthy practice that can prevent many diseases such as traumatic onycholysis and transmission of threadworm infestations (Harcup, 1995). Scratching the skin with long nails due to itchy skin conditions, such as eczema and atopic dermatitis, can aggravate the condition and result in dyspigmentation and scarring (Ruiz-Maldonado and OrozcoCovarrubias, 1997).
Genital hygiene in men includes washing the penis, scrotum and testicles, anus, and pubic hair with water and mild soap, as genital microbial pathogens can be carried on the skin of male genitals (Steele et al., 2004). Washing the anal area after defecation is a treatment for pruritus ani. Although an individual may not be aware of occult soiling, it can become itchy and lead to scratching (Siddiqi et al., 2008 Sep).
5. Nail care in Islam
7. Circumcision in Islam 6. Genital hygiene and Islam 6.1. Washing with water The private parts should be washed with water after urinating or defecating. Anas narrated, ‘‘Once, the Prophet (pbuh) came to us after relieving himself and washing himself with water’’ (Al-Bukhari, 1987a). In another narration he stated, ‘‘Whenever the Prophet (pbuh) went to relieve himself, I used to bring water with which he used to wash his private parts’’ (Al-Bukhari, 1987b). 6.2. Istejmar Istejmar involves purifying the front and back of the private parts from urine or feces using stones or alternative material such as tissue paper. Cleaning with this method should be repeated at least three times. Use of impure substances, such as livestock waste (dung), bones, or edible items, is prohibited (Othaimeen, 2009). According to a narration by Salman, the Prophet (pbuh) disapproved of using less than three stones. Salman reported that someone addressed him saying, ‘‘Your Prophet taught you everything, even how to clean yourselves from excrement? He replied, yes, the Prophet taught us not to use the right hand
The Prophet (pbuh) ordered the males to undergo circumcision. Abu Huraira narrated that the Prophet (pbuh) said, ‘‘five are the acts akin to Fitra: circumcision, etc. . .’’ (Al-Bukhari, 1987). 7.1. Circumcision in contemporary medicine Dead skin and an oil-like substance can accumulate under the foreskin to form a substance called smegma. If smegma is not washed from underneath the foreskin, it can build up, harden and lead to infection and disease (Van Howe, 2009 August). Circumcised men are less likely to have symptomatic genital ulcer disease, (Hoborn, 1981) and a meta-analysis suggested that circumcision is associated with reduced rates of ulceration due to herpes virus, syphilis and other sexually transmitted infections (STIs) (Weiss et al., 2006). Reduced male carriage of these pathogens may lower the rates of transmission of these ulcerative STIs to women. The moist subpreputial space in uncircumcised men may enhance the survival of trichomonas and gram negative anaerobes associated with bacterial vaginosis. Removal of the foreskin could reduce female’s exposure to these pathogens (O’Farrell, 2006). Human immunodeficiency virus (HIV) prevalence is likely to be lower in circumcised male partners (Larke, 2010).
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Skin care: Historical and contemporary views In March 2007 the World Health Organization (WHO) and the United Nations Joint Programme on AIDS (UNAIDS) recommended that male circumcision should be considered as part of a comprehensive HIV prevention package (WHO, 2007). 8. Conclusion Skin care is an essential part of personal hygiene and well being. Islam has always placed a strong emphasis on hygiene. In addition to the need to be ritually clean at the time of the daily prayer through ablution and ritual bath, there are a large number of other hygiene-related rules governing the lives of Muslims. In general, the Qur’an advises Muslims to uphold high standards of physical hygiene and to be ritually clean whenever possible. The proper care of skin and related appendages and orifices is important in contemporary medicine because unclean skin favors the development of pathogenic organisms and infections. References Al-Albani, Muhammad, 1985. Irwa’ al-Ghaleel fi Takhreej Ahaadith Manar al-Sabeel 1 (66), 105. Al-Albani, Muhammad, 1985. Al-Selselah al-Saheehah. al-Maktabah al-Islamiyyah, Beirut, 1, 899. Al-Albani, Muhammad, 1987. Sahih. Dar al-Qalam, Beirut, no. 899. Al-Albani, Muhammad, 1987. Sahih. Dar al-Qalam, Beirut, no. 3295. Al-Albani, Muhammad, 1987. Sahih. Dar al-Qalam, Beirut, no. 254. Al-Albani, Muhammad, 1987. Sahih. Dar al-Qalam, Beirut, no. 5923. Al-Albani, Muhammad, 1987. Sahih. Dar al-Qalam, Beirut, no. 5889. Al-Albani, Muhammad, 1987a. Sahih. Dar al-Qalam, Beirut, no. 300. Al-Albani, Muhammad, 1987. Sahih. Dar al-Qalam, Beirut, 153–1545630. Al-Albani, Muhammad, 1987. Sahih. Dar al-Qalam, Beirut, no. 159. Al-Albani, Muhammad, 1987. Sahih. Dar al-Qalam, Beirut, no. 221– 5609. Al-Albani, Muhammad, 1987. Sahih. Dar al-Qalam, Beirut, no. 150, 151. Al-Albani, Muhammad, 1987. Sahih. Dar al-Qalam, Beirut, no. 848– 879-880. Al-Albani, Muhammad, 1987. Sahih. Dar al-Qalam, Beirut, no. 168. Al-Albani, Muhammad, 1987. Sahih. Dar al-Qalam, Beirut, no. 191. Al-Albani, Muhammad, 1987. Sahih. Dar al-Qalam, Beirut, no. 887. Al-Albani, Muhammad, 1987b. Sahih. Dar al-Qalam, Beirut, no. 217. Al-Albani, Muhammad, 1987. Sahih. Dar al-Qalam, Beirut, no. 897– 898. Al-Albani, Muhammad, 1988. Sahih. Dar al-Qalam, Beirut, 1, 46–47. Al-Mustadrak. Beirut: Dar al-Ma’rifah, vol. 4, p. 272 (n.d.) (1979). Al-Nasaai, Ahmad, 1986. Sunan. Dar al-‘Asha’ir, Damascus, 1, 108. Al-Nasaai, Ahmad, 1986. Sunan. Dar al-‘Asha’ir, Damascus, 5. Al-Naysaburi, Muslim, 1972. Sahih. Dar Ihia’ al-Turath, Beirut, no. 278. Al-Naysaburi, Muslim, 1972. Sahih. Dar Ihia’ al-Turath, Beirut, no. 259. Al-Naysaburi, Muslim, 1972. Sahih. Dar Ihia’ al-Turath, Beirut, no. 258. Al-Al-Naysaburi, Muslim, 1972. Sahih. Dar Ihia’ al-Turath, Beirut, no. 262. Al-Otaibi, M., Al-Harthy, M., Gustafsson, A., et al, 2004. Subgingival plaque microbiota in Saudi Arabians after use of miswak chewing stick and toothbrush. J. Clin. Periodontol. 31 (12), 1048–1053. Al-Tirmithi, Muhammad., 1983. Sunan. Beirut: Dar Al-Fikr, p. 778.
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