A new study published in BMJ Case Reports highlighted a potential health risk associated with a traditional South Asian garment: the tightly tied waist cord of the saree underskirt or petticoat. This practice, which is popular in rural India, has the potential to cause a type of skin cancer known as a Marjolin ulcer, which some refer to as "petticoat cancer." The study underscores the risks of persistent friction and pressure on the skin due to the tight waist cords commonly worn with sarees, using examples from two women who developed cancer.

The study describes two cases. The first case included a 70-year-old lady who had a chronic skin lesion on her right flank that did not heal for 18 months. Upon examination, the skin around the ulcer seemed depigmented, indicating chronic pressure from the tightly wrapped petticoat cord. A biopsy revealed a Marjolin ulcer, a kind of squamous cell carcinoma renowned for its aggressiveness. In the second example, a woman in her late 60s had a similar ulcer that resisted healing for two years. She had been wearing a 'lugda,' a traditional saree version, firmly around her waist without an underskirt for almost 40 years. Unfortunately, her cancer had already progressed to a lymph node by the time she sought treatment.

 Marjorolin ulcers are rare but severe skin tumors that usually appear in areas of chronic inflammation, such as burn scars or non-healing wounds. The authors suggest that friction or pressure-induced chronic irritation can promote malignant transformation. The authors state that the exact process by which chronic ulcers or wounds turn malignant remains unknown, despite the proposal of numerous theories. Continuous irritated (chronically inflamed) cutaneous lesions have a higher risk of developing malignant transformation. Constant pressure around the waist can induce cutaneous atrophy, eventually leading to erosion, ulceration, and, in severe cases, malignancy.

 In these circumstances, the authors recommend wearing a loose petticoat or choosing less tight attire, especially if skin discomfort is present. Allowing the skin to recover by decreasing pressure and friction may reduce the likelihood of such cancers. They emphasize the need to reconsider traditional clothing practices, especially when health issues arise.

 The 70-year-old sufferer described her own experience with the disease. "I have been wearing a Nauvari saree, tightly wrapped around my waist, for most of my adult life," she told me. "Six years ago, I discovered a small spot of depigmentation on my right flank that I initially ignored as a minor skin problem. This lesion eventually developed into a non-healing ulcer, causing me concern and suffering." She detailed how the continuous friction affected her daily life, ultimately leading to a skin cancer diagnosis. Reflecting on her adventure, she stated, "This has been a psychologically and physically demanding journey. It emphasizes the necessity of recognizing chronic skin abnormalities and seeking medical attention as soon as possible. I hope that my tale will improve women's awareness of the health hazards involved with traditional clothing practices."

 The findings in BMJ Case Reports highlight the importance of raising public knowledge of traditional clothing practices and their possible influence on skin health, especially in rural and conservative areas where such dress is still culturally prominent. Early diagnostic and prevention actions, such as looser clothing, may help lessen the hazards linked with chronic skin pressure and friction.