Waist dermatoses in Indian women wearing saree

Introduction

Saree is a type of female costume unique to Indian subcontinent. Whether it is an ideal outfit for our climate is debatable. To make matters worse, they wear a skirt underneath fastened securely to the waist by a cord. Various dermatoses like allergic and non-allergic contact dermatitis[1] and dermatophytosis[2] are more common in body folds especially when associated with increased sweating.

These tight garments induce various dermatoses along the waist in our female patients. This is often aggravated by the hot and humid climate of certain areas.

We undertook this study in the coastal city of Chennai, to assess the prevalence and presentation of various dermatoses along the waist in our female patients wearing saree.

Materials and Methods

We selected all female patients wearing saree who visited our department during a two weeks period. Demographic profile, presence of any waist lesions and other relevant data were recorded on a proforma. Statistical analysis was done using the Epi Info software.

Result

We collected data from 140 female pa-tients with a mean age of 44.92. Most of our pa-tients were married (97.9%) and were house wives. 99 patients (70.7%) had waist lesions, but only 26 (18.6%) patients complained of symp-toms. Other patients came with unrelated condi-tions and considered their waist lesions to be nor-mal. Among these 26 patients 22 had pruritut over the site. The duration of the lesions in these patients ranged form 1 month to 2 years. 120 patients (85.7%) wore saree throughout the day 32 (22.9%) patients wore predominantly cotton saree, 90 (64.3%) wore synthetic ones and the rest wore both for almost equal duration. 17 patients (12.1%) were atopic and 21 (15%) were diabetic. 65 patients (46.4%) were obese. Lesions seen over the site are shown in [Table - 1].

Scraping was done in 20 suspected cases of tnea corporis, out of which 1 1 were positive. Specific lesions seen over the waist are listed in [Table - 2]

We tried to assess probable association of any waist lesion of any waist like atopy, diabetes, type of fabric, obesity and skin types using chi--square test. The P--values are listed in [Table - 3].

Discussion

Pigmentation and mild scaling over the waist have become so common in females here that they have started considering it as normal. Only 22 out of 99 patients with waist lesions admitted that they had a skin problem over the same site.

We could not find any association with factors, which are commonly accompanied by flexural dermatoses like diabetes,[3] obesity and atopy.[4] We failed to find an association with any particular type of fabric also.

After completion of the study we examined few of our patients wearing other attires with out the tight cord around the waist and we found that they did not have any of these changes. Hence we feel that, perhaps the only factor determining the frequency of waist dermatoses in our patients is the tightness with which they tie the cord of their skirt along their waist. Hence we recommend the use of broad belts with hooks, .instead of the thin cord, which will considerably reduce the pressure over the site.

We found that few cases of vitiligo and lichen planus, in addition to lesions elsewhere, had similar lesions along the waist. This probably represents Koebner′s phenomena because of the excessive friction in these areas.

Tinea corporis was clinically diagnosed only in 18 patients out of whom 11 were positive for KOH preparation. So dermatophytosis is not as prevalent as one might expect.

In conclusion, most of our female patients wearing saree showed some skin changes along their waist, which is not related to factors like diabetes, atopy, obesity, or type of saree.