Cement Dermatitis

Cement dermatitis is skin disease from contact with wet cement, mortar or concrete. It includes irritant contact dermatitis, allergic contact dermatitis (mainly to hexavalent chromium, cobalt and nickel) and chemical burns from alkali.

Exposure. Bricklayers, plasterers, concrete finishers, tile setters, labourers and anyone kneeling or handling wet mix.

Epidemiology. Among the commonest causes of occupational contact dermatitis in construction. Rates of chromate allergy fell where ferrous sulphate is added to cement.

Alkali burns. Wet cement has a pH of about 12 to 13 and can cause deep burns with little initial pain, usually after prolonged contact under boots or kneepads.

Course. Irritant disease may resolve with protection. Allergic disease often becomes chronic.

Pathophysiology.

Alkalinity, hygroscopic drying and abrasive sand damage the stratum corneum, causing irritant dermatitis. Prolonged contact causes liquefactive necrosis.

Soluble hexavalent chromium, with cobalt and nickel contaminants, acts as hapten in allergic disease.

• Dry, cracked, fissured hands with erythema and scaling; itching.
• Wet cement burns: erythema, blistering or ulceration of knees, ankles, hands or feet that appear hours after exposure.
• Chronic allergic eczema of the hands and forearms with lichenification.

Red flags.

• Deep ulceration, blistering or necrosis from cement contact.
• Eye contamination, pain or loss of vision.
• Spreading erythema or pus (infection).

• Exposure history including cement contact time, boots, gloves and kneeling.
• Examination of burns for depth and extent.
• Patch testing for chromate, cobalt and nickel when disease is chronic or relapsing; read at day 2 and day 4 or later.
• Swabs for infection; eye examination including pH testing after exposure.

Differential diagnosis. Irritant dermatitis from other chemicals, allergic dermatitis to rubber or epoxy resin, atopic eczema, psoriasis, tinea, thermal burn.

• Cement contact: brush off dry cement, then irrigate continuously with running water for at least 30 minutes, longer for alkali until pH is neutral; remove contaminated clothing and boots. Do not neutralise with acid.
• Eye exposure: immediate irrigation with copious water and emergency ophthalmology review.
• Burns: assess depth and area; refer deep or extensive burns to a burns service; tetanus prophylaxis by immunisation status.
• Analgesia: paracetamol 1 g orally every 6 hours as needed, maximum 4 g in 24 hours (3 g if under 50 kg, chronic alcohol excess or liver disease), for the shortest period that controls pain. Monitor liver function with prolonged use. Reduce dose in hepatic impairment; extend dosing interval when eGFR is under 30.
• Prevention: waterproof boots and kneepads, long sleeved overalls, nitrile gloves with long cuffs, immediate washing of splashes, and iron sulphate treated cement.
• Emollient applied liberally at least twice daily and after each handwash, long term.
• Clobetasol propionate 0.05% ointment topically to affected skin once or twice daily for up to 2 weeks, maximum 50 g weekly. Monitor skin atrophy, striae, telangiectasia and infection. Avoid on the face, flexures and genitals and on infected skin; use the lowest potency that works in pregnancy and avoid in children.
• Chronic allergic disease usually requires job change.

Monitoring. Review burns at 24 to 48 hours; chronic dermatitis at 4 to 6 weeks, then every 3 months.

Referral and escalation. Burns service for deep, circumferential or large burns; ophthalmology for eye exposure; dermatology for patch testing; notification and compensation where required.

Special groups. Pregnancy: avoid potent steroids over large areas.