How to Treat Concrete and Cement Burns on the Skin

Any construction worker knows the importance of being cautious about the risks associated with concrete. Most people are familiar with concrete-related hazards like crush injuries, silicosis, and even asbestos-containing concrete. However, many people underestimate one of the most common cement-related injuries: concrete chemical burns, also known as cement burns.

Nearly every construction project includes concrete and cement products, and it's easy to become too comfortable with such familiar material. It's important for workers to understand the risks of concrete-related skin injuries. Read more below to learn more about concrete burns, what causes them, and their treatment.

WHAT ARE CONCRETE BURNS? 

A concrete burn, also known as a cement burn or concrete poisoning, is a chemical burn caused when wet cement comes into contact with skin. Concrete burns can cause severe pain, discoloration, blisters, swelling, bleeding, and ulcerations.

A concrete burn should never be taken lightly. It can be serious and result in scarring, skin grafts, or even amputation.

HOW DOES CONCRETE BURN YOU?

As previously stated, concrete burns occur when concrete makes contact with the skin. Usually, prolonged skin contact is caused by concrete being stuck beneath gloves or garments.

The difference between minor and serious burns is relative to how long the cement is in contact with the skin. Burns will worsen the longer the cement is in contact with the skin.

Often, the burn is already serious when it is noticed. That is why proper personal protective equipment is vital. Keeping concrete off your skin at all times is the only method of prevention.  

Additionally, concrete powder can be ingested or breathed, which can cause gastrointestinal and respiratory problems.

According to A Safety & Health Practitioner's Guide to Skin Protection, there are four skin problems caused by cement-containing products. In order of seriousness, they are:

• Dry Skin or Irritation - This is mild ICD, or "concrete rash."
• Acute or Chronic Irritant Contact Dermatitis (ICD) -  ICD, the chemical composition caused by cement or concrete reacting with skin, causes redness, scaling, and blistering. While curable, multiple bouts can lead to ACD.
• Allergic Contact Dermatitis (ACD) - ACD is caused by an immune response to cement or concrete ingredients. ICD and ACD both require diagnostic tests, but ACD can develop without warning and is difficult to cure.
• Caustic Burns (or Cement Burns) - Cement products can cause second or third-degree burns, leading to blisters, dead skin, and discoloration. Severe cases can go down to the bone, meaning scarring, disability, skin grafts, and amputation.

WHY DOES CONCRETE BURN YOU?

There are three factors in concrete poisoning: the abrasiveness of concrete mixtures, cement's alkaline (high pH) nature, and the chemical and metal content.

Cement, which you find in concrete, mortar, and grout, is highly caustic or corrosive. Once you mix dry cement with water, it has a pH of 10 to 12 (on a scale of 14) until it cures and dries. That, by itself, is enough to cause chemical burns on unbroken skin with extended contact.

Usually, your skin has a pH of 5.4-5.9, depending on the location. Being a little acidic helps keep moisture and bacteria out of your body. Contact with cement makes your skin more alkaline and permeable.

Portland cement, specifically, often contains the metal hexavalent chromium. It's toxic chromium that sensitizes your skin and causes contact dermatitis. Hexavalent chromium has been classified as a carcinogen, which can cause cancer. Certain epoxies, accelerators, water reducers, superplasticizers, retardants, and other admixtures in concrete can also have a sensitizing effect.

Finally, concrete and Portland cement are abrasive, creating microscopic cuts and scrapes on your skin. This allows the alkaline, toxic substance to contact deeper tissues and worsen the injury.

HOW TO TREAT CONCRETE BURNS

With those two things in mind, what do you put on a concrete burn, and what's the best concrete burn treatment protocol to follow when exposed?

1. Remove Concrete Dust and Wet Protective Gear Immediately

If you suspect you have concrete burns or have been splashed with wet concrete while wearing permeable clothes, remove any clothing, jewelry, or protective gear immediately to prevent the trapping of wet concrete against your skin.

Since water activates dry cement's destructive properties, brush any concrete powder off your skin before washing the area. Otherwise, you're creating more exposure to wet cement. Use a dry towel or brush.

2. Flush the Area with Water & Concrete Burn Neutralizer for 20 Minutes

To prevent chemical damage, rinse exposed skin with cold water for 20 minutes. Add vinegar or another acidic substance to neutralize alkalinity. This process can save tissue and prevent severe damage, even if you're already on your way to the hospital.

If you get wet concrete splatter on your face or eyes, wash them for 15 minutes with cold, clean water, making sure to get all the debris out of your tissues, fornices, and under your eyes.

3. Do Not Immediately Apply Lotions, Creams, or Petroleum Jelly

While clean water and neutralizing agents are a "yes" for cement burns, most other substances are a "no." We're used to thinking about creams or lotions to relieve the sting of a burn. Still, petroleum jelly, lanolin lotion, and many creams can trap contaminants against the skin, causing concrete burns to worsen.

4. Call 911

If a concrete burn is more significant than three inches across, is very deep, or covers the hands, feet, face, groin, or a major joint, call 911 immediately and follow the steps above while you wait for an ambulance.

WHO IS AT RISK FOR CEMENT BURNS?

At least a quarter-million people in the U.S. work directly with fresh cement-containing products, including wet concrete, mortar, plaster, grout, stucco, or terrazzo, which exposes them to concrete skin irritation, contact dermatitis, and concrete burns on their skin.

A study examining 165 cement burns from 1950-2006 found that the worst cases had exposure times of up to 6 hours and treatment delays of nearly two weeks. Patients may stay in the hospital for up to a month, with a total healing time of 2-7 weeks.

Tasks that put you at risk for concrete burns include:

• Tendency concrete pouring
• Mixing and spreading grout
• Preparing cement underlayer for terrazzo
• Hosing ready mixed concrete, mixer, and chute
• Setting brick, cinder block, and masonry
• Dismantling formwork contaminated by Portland cement
• Pouring, leveling, smoothing, and finishing concrete
• Attaching tiles to walls, floors, and ceilings
• Applying plaster, stucco, and EIFS
• Spraying Portland cement products
• Grinding finished concrete releases cement dust

WHAT YOU NEED TO KNOW ABOUT TREATING CEMENT BURNS

Acting early is crucial for treating cement burns. If you notice any burns on your skin, seek medical attention immediately. Even if only pinkness appears, the burn may worsen without proper treatment. Washing away chemicals is effective, but it's not enough.

Disclosing concrete exposure immediately can save lives. Concrete burns are treated very differently than other burns but can look identical. Regular burn treatment can make cement burns worse. Even if you're unsure what caused your burn, you should tell medical professionals when and how you were exposed to fresh concrete. Concrete burns can appear hours or even days after exposure.

HOW TO PROTECT YOURSELF AGAINST CEMENT BURNS 

OSHA's concrete standards and recommendations emphasize the importance of well-maintained and impervious personal protective equipment (PPE) in preventing cement burns on the job, protecting hands, arms, legs, feet, and eyes from direct contact with concrete or cement.

Proper hygiene and worksite supplies are essential for preventing concrete burn injuries. Keep first aid kits, pH-indicating strips, clean water, neutralizers, and clean towels on-site. Ensure everyone has several gallons of water, pH-neutral soap, and clean towels for emergencies, and use eye-wash stations with a 15-minute flush. Workers should store concrete PPE separately from other tools and supplies, change before entering their vehicle, and leave it at work to prevent contamination of upholstery and clothing.

Finally, it's essential to provide training in the hazards of cement work and the safety measures to prevent injury. This can be done through yearly formal training, such as online courses, and regular reminders during toolbox talks or informal gatherings, which significantly improve safety compliance. At 360training.com, you’re just a few clicks away from meeting OSHA’s 10-Hour Construction or General Industry training requirements! Contact us to find out how you can complete the course and keep your team safe!

Steps to Treat Concrete Burns

With those two things in mind, what do you put on a concrete burn, and what's the best concrete burn treatment protocol to follow when exposed?

1. Remove Concrete Dust and Wet Protective Gear Immediately

If you suspect you're experiencing a concrete burn or get splashed with wet concrete while wearing permeable clothes, immediately (and carefully) remove any clothing, jewelry, or protective gear. These items can trap wet concrete against your skin, prolonging your exposure to burns.

Since water activates dry cement's destructive properties, brush any concrete powder off your skin before washing the area. Otherwise, you're creating more exposure to wet cement. Use a dry towel or brush.

2. Flush the Area With Water & Concrete Burn Neutralizer for 20 Minutes

Continually rinse the potentially exposed skin with cold running water for 20 minutes. Adding vinegar or another mildly acidic substance to the water can neutralize the alkalinity and stop the chemical damage from worsening.

Even if you're already on the way to the hospital, flushing the skin continuously can save tissue and prevent more severe damage.

If wet concrete splatter may have contacted your face or eyes, you should flush your eyes with clean, cool water for 15 minutes. Be sure to thoroughly clean out the fornices, the tissue, and the space between the eye and the eyelid.

3. Do Not Immediately Apply Lotions, Creams, or Petroleum Jelly

While clean water and neutralizing agents are a "yes" for cement burns, most other substances are a "no."

We're used to thinking about creams or lotions to relieve the sting of a burn. Still, petroleum jelly, lanolin lotion, and many creams can trap contaminants against the skin, causing concrete burns to worsen.

4. Call 911

If a concrete burn is more significant than three inches across, is very deep, or covers the hands, feet, face, groin, or a major joint, call 911 immediately and follow the steps above while you wait for an ambulance. Can Concrete Burn You?

Yes, and the consequences can be severe. Concrete or cement products can cause third-degree chemical burns. Burns take so long to develop (sometimes hours) that it may be too late to prevent more serious injuries by the time you notice even the mild symptoms.

According to A Safety & Health Practitioner's Guide to Skin Protection, there are four skin problems caused by cement-containing products. In order of seriousness, they are:

• Dry Skin or Irritation. This is mild ICD, or "concrete rash."
• Acute or Chronic Irritant Contact Dermatitis (ICD). ICD is caused directly by the chemical composition of cement or concrete reacting with your skin to cause redness, scaling, and blistering. ICD is curable, but multiple bouts can lead to ACD.
• Allergic Contact Dermatitis (ACD). While the chemicals cause ICD in the cement, ACD is caused by an immune response to cement or concrete ingredients. ICD and ACD look similar and require diagnostics tests to tell them apart. There's no way to tell who will develop ACD; it can develop without any warning and isn't easy to cure. ACD drives many cement workers out of business.
• Caustic Burns (or Cement Burns). Cement products can cause second or third-degree burns after a reasonably short exposure. Symptoms include blisters, dead or hardened skin, and black or green discoloration. In severe cases, cement burns will go down to the bone. They can cause scarring, disability, skin grafts, and even amputation.

How & Why Does Concrete Burn You?

There are three factors in concrete poisoning: the abrasiveness of concrete mixtures, cement's alkaline (high pH) nature, and the chemical and metal content.

Cement, which you find in concrete, mortar, and grout, is highly caustic or corrosive. Once you mix dry cement with water, it has a pH of 10 to 12 (on a scale of 14) until it cures and dries. That, by itself, is enough to cause chemical burns on unbroken skin with extended contact. ⁽¹⁾

Usually, your skin has a pH of 5.4-5.9, depending on the location. Being a little acidic helps keep moisture and bacteria out of your body ⁽²⁾. Contact with cement makes your skin more alkaline and permeable.

Portland cement, specifically, often contains the metal hexavalent chromium. It's toxic chromium that sensitizes your skin and causes contact dermatitis. Hexavalent chromium has been classified as a carcinogen, which can cause cancer ⁽³⁾. Certain epoxies, accelerators, water reducers, superplasticizers, retardants, and other admixtures in concrete can also have a sensitizing effect ⁽¹⁾​​​​​​.

Finally, concrete and Portland cement are abrasive, creating microscopic cuts and scrapes on your skin. This allows the alkaline, toxic substance to contact deeper tissues and worsen the injury ^(1,3). 

Who Is At Risk for Cement Burns?

Anyone who works with or around fresh cement-containing products, including wet concrete, mortar, plaster, grout, stucco, or terrazzo, is at risk for concrete burns on their skin. At least a quarter-million people in the U.S. working directly with these fresh cement products, which puts them at risk for concrete skin irritation, contact dermatitis, and concrete burns on the skin. ⁽¹⁾

A large study that reviewed 165 cement burns between 1950 - 2006 showed that the worst of cases had an exposure time as long as 6 hours with a treatment delay spanning nearly two weeks. In these cases, some patients stayed in the hospital for upwards of 1 month, with a total healing time ranging between 2 - 7 weeks ⁽⁴⁾. If you suspect you’ve been exposed to cement, do not delay quickly removing the treating burn.

Tasks that put you at risk for concrete burns include:

• Tending concrete pour.
• Mixing and spreading grout.
• Preparing cement underlayer for terrazzo.
• Hosing out ready mixed con, mixer, and chute.
• Using mortar to set brick, cinder block, and another masonry.
• Dismantling formwork contaminated by Portland cement.
• Pouring, leveling, smoothing, and finishing concrete.
• Attaching tiles to walls, floors, and ceilings.
• Mixing mortar and providing it to other craft workers.
• Mixing and applying plaster, stucco, and EIFS.
• Spraying Portland cement products such as fireproofing, gunite, or shotcrete.
• Grinding finished concrete, which releases cement dust. 

The most important things to know about cement burn treatment are:

• Acting early is critical. If you work around concrete and find any burns on your skin, tell a medical professional immediately. Even if you only see pinkness, you can't assume the burn will stop there. Washing away the chemicals is good, but the burns could worsen without treatment.
• Disclosing concrete exposure can save your life. Concrete burns are treated very differently than other burns but can look identical. Regular burn treatment can make cement burns worse. Even if you're unsure what caused your burn, you should tell medical professionals when and how you were exposed to fresh concrete. Concrete burns can appear hours or even days after exposure.

How to Prevent Cement Burns

OSHA has specific standards and recommendations to help you prevent cement burns on the job.

Well-maintained and impervious personal protective equipment (PPE) is crucial for protecting hands, arms, legs, feet, and eyes from direct contact with fresh concrete or cement.

Proper hygiene and relevant worksite supplies are also crucial. Keep concrete burn first aid kits on-site, including pH-indicating strips, to check exposure. Anyone working with fresh cement products needs clean water and concrete burn neutralizers. The average person needs several gallons of water available in an exposure emergency, pH-neutral soap, and clean towels. Eye-wash stations capable of a 15-minute flush are necessary, as well.

Encourage workers to store dedicated concrete PPE separately from other tools and supplies. They should change before entering their vehicle and leave these items at work; if that's not possible, they should avoid contaminating their upholstery and other clothing.

Finally, it's essential to provide training in the hazards of cement work and the safety measures to prevent injury. This can be handled through yearly formal training, like online construction safety courses in the appropriate language. Regular reminders, given during a toolbox talk or other informal gatherings, can also make a big difference in safety compliance.

Sources:
1.    Kaushik, S., Bird, S. (2022). Topical chemical burns: initial assessment and management. UpToDate. Topic last updated: Oct 16, 2022. It was retrieved on Nov 22, 2022. 
2.    Braun-Falco O, Korting HC. Der normale pH-Wert der menschlichen Haut [Normal pH value of human skin]. Hautarzt. 1986 Mar;37(3):126-9. Retrieved Nov 22, 2022 from https://pubmed.ncbi.nlm.nih.gov/3700100.
3.    Klemm, WA. (1994). Hexavalent Chromium in Portland Cement. ASTM International, 16(1). Retrieved Nov 22, 2022, from https://www.astm.org/cca10560j.html.
4.    Joseph Y. Chung, MD, Areta Kowal-Vern, MD, Barbara A. Latenser, MD, FACS, Robert W. Lewis, II, PA-C. (2007). Cement-Related Injuries: Review of a Series, the National Burn Repository, and the Prevailing Literature, Journal of Burn Care & Research, 28(6), 827–834. Retrieved Nov 22, 2022, from https://doi.org/10.1097/BCR.0b013e3181599bb1.