How to Treat Concrete and Cement Burns on the Skin
Most people are familiar with concrete-related hazards like crush injuries, silicosis, and even asbestos-containing concrete, but many people underestimate one of the most insidious cement-related injuries: concrete chemical burns, also known as cement burns or concrete poisoning.
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.
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.
