The report in the BMJ highlights two cases of older women who developed this rare and aggressive type of skin cancer—linked to prolonged, tight binding of saree waist cords
Published Nov 07, 2024 | 7:00 AM ⚊ Updated Nov 07, 2024 | 11:22 AM
Tying of drawstring very tightly can cause 'Saree Cancer' also known as 'Petticoat Cancer' in rare cases.
A daily habit shared by millions across India — tying a saree, salwar, or dhoti too tightly — might seem harmless, but medical experts warn it can lead to surprising health risks, including cancer in rare cases.
A recent study in the BMJ Case Reports has revealed that the simple act of securing clothing too snugly around the waist could lead to skin disorders, digestive discomfort, and even a rare form of cancer dubbed ‘petticoat cancer ’ also known as ‘saree cancer’.
Authors of the report from the Department of Dermatology, Venereology and Leprosy in Datta Meghe Institute of Higher Education and Research at Jawaharlal Nehru Medical College in Wardha observed ‘Marjolin ulcer’ of the waist – a rare, site-specific skin cancer in some South Asian women, typically developing in areas where clothing is secured tightly, such as the waist.
Dr Abhiram Rayapati, consultant Dermatologist, dermatosurgeon and cosmetologist at iSkin clinic in Bengaluru who’s not connected with the study, explained ‘petticoat cancer’.
He said Marjolin ulcer or drawstring dermatitis is a kind of frictional dermatitis that occurs due to chronic irritation and friction from tightly tied garments like saree petticoat cords, salwars, or dhotis, leading to prolonged inflammation and, over time, malignant transformation of skin cells.
“Repeated friction damages the skin, causing it to become susceptible to squamous cell carcinoma — Marjolin ulcer in the context of this study. This condition highlights the importance of minimising constant pressure and friction on the skin to reduce the risk of such malignant developments,” Dr Abhiram told South First.
According to Dr Divya Sharma, it is called saree cancer or petticoat cancer because it is found around the waistline.
Saree cancer is a rare type of squamous cell carcinoma (SCC). Saree and dhoti are traditional male and female costumes, respectively, which are unique to the Indian subcontinent.
The report in the BMJ highlights two cases of older women who developed this rare and aggressive type of skin cancer — linked to prolonged, tight binding of saree waist cords.
“We cannot say it occurs only due to sarees, because squamous cell skin cancer is anyway very rare. This cancer was also reported in Kashmir when people used kangdis to heat their abdomens,” Dr Divya told South First.
“A chronic burn, what we call a Marjolin ulcer, can also turn into cancer. Incidentally, the hypothesis that the ulcers became malignant cancers due to frequent contact with sarees or petticoats is a postulated one. It is not that everyone who wears sarees or petticoats can get one.”
“I’m sure that there is some genetic disposition also. It should not be a cause for concern for people who wear a saree, petticoat or dhoti. However, if people develop thick scars due to multiple injuries in the same area, it is a cause for concern,” she added.
In one case, a 70-year-old woman developed a persistent ulcer with pigmentation loss on her right side, caused by her tightly tied petticoat cord, which led to squamous cell carcinoma.
In another case, a woman in her late 60s, who wore a lugda (a traditional saree style tied directly to the waist without an underskirt), experienced a similar ulcer that eventually spread to her lymph nodes.
The authors explained that Marjolin ulcers typically arise in areas of chronic irritation or long-standing wounds, where constant pressure and inflammation increase the risk of malignant transformation. “Sustained waist pressure can thin the skin, leading to erosion and ulceration that may turn cancerous,” the report said.
Meanwhile, in 2014, another case study from India also mentioned a case of a 50-year-old woman who went to the hospital with the symptoms of itching and a non-healing ulcerative lesion on her waistline.
The woman had worn a saree the same way, with a knot tied tightly at her waist, for 34 years. Over time, this tight knot created an ulcer, or open sore, that gradually developed into cancer.
An MRI scan revealed that the cancer had spread to her lymph nodes. To treat this, she underwent surgery to remove the cancerous growth, followed by chemotherapy and radiation therapy. After two years of treatment, she was in remission, meaning there were no signs of cancer left.
The doctors who published her case emphasised that awareness of “saree cancer” is crucial for Indian women to prevent similar issues. They recommended a combination of surgery, chemotherapy, and radiation as the best treatment approach for such cases.
Dr Abhiram explained that skin cancers are uncommon malignancies, comprising less than one percent of all cancers in India.
However, he noted that traditionally tight garments like sarees, dhotis, and salwar-kameez cause chronic friction. In humid environments, this friction combined with sweating can lead to infections from candida, dermatophytes, and bacteria.
He further explained that wearing such garments tightly around the waist constantly can lead to pigmentation and scaling of the skin—a condition known as acanthosis—which may also scar the area. In rare cases, when ulceration occurs, malignant changes can develop.
“The process of repeated trauma over a long time and the consequent interference with the healing process may be the reason for malignant transformation,” Dr Abhiram explained.
In males, there is the same mechanism which is called, ‘dhoti cancer’, a type of squamous cell carcinoma of the skin.
Doctors explain that tying a drawstring too tightly around the waist can impede blood circulation to the lower part of the body.
When the waistband is tightly compressed against the skin, it can cause reduced blood flow, leading to numbness and, in severe cases, nerve damage in the abdominal and hip region, as constant pressure on the veins can slow down blood flow to the legs and hips.
A tight drawstring or wearing of any tight clothes around the waist can exert pressure on the stomach, making it harder for it to expand properly after meals. This pressure can lead to acid reflux, causing heartburn and discomfort.
A tightly bound waist can interfere with normal digestion. The abdominal organs need space to function, and a compressed abdomen can lead to bloating and cramping. For those predisposed to hernias, chronic pressure can even aggravate the condition.
Loosen up: Ensure the drawstring is snug but not overly tight. You should be able to slide your finger comfortably between the waistband and your skin.
Switch to broad or elastic waistbands: Modern saree petticoats with elastic waistbands or broad waistbands can reduce friction and are less likely to cause skin issues. Here, the pressure is distributed evenly, making it less likely to dig into the skin.
Give skin breaks: For those who wear sarees daily, giving the skin a break can help prevent irritation and inflammation.
Seek medical advice for persistent irritation: If you notice skin changes or experience recurring irritation around the waistline, consult a dermatologist to assess and prevent potential complications.
(Edited by Ananya Ra0).
