Allergic cement eczema

By adding ferrous sulfate to the cement, it is possible to prevent the development of allergic cement eczema. This was illustrated in an epidemiological intervention study from Denmark (Avnstorp 1992) and in reports from Finland and Sweden (Roto et al. 1996). 

In general, irritant cement eczema cannot be differentiated from allergic cement eczema clinically. This differentiation should be made after patch testing. If the test reveals a positive reaction to chromate, the eczema must be classified as allergic cement eczema (Avnstorp 1992). The severity of irritant cement eczema with respect to extension has been found to be mild to moderate, whereas allergic cement eczema has tended to be more severe (Avnstorp 1991). 

Irritant cement eczema should, in part, be prevented by automation of work processes whenever possible. The risk of developing allergic cement eczema could be brought to a very low level by the addition of ferrous sulfate to the cement (Avnstorp 1992). Ferrous sulfate reduces the allergenic Cr(VI) to Cr(III) in the cement (see section on Reduction and Solubility), In Scandinavian countries, this intervention has shown to be a significantly effective method in the prevention of allergic cement eczema (Avnstorp 1992 Roto et al. 1996 Zachariae et al. 1996). 

Reduced numbers of statements and approved claims of cement eczema have been found following the addition of ferrous sulfate to cement in Denmark and Finland (Avnstorp 1992 Roto et al. 1996). This economic benefit should be included in the calculation together with spared costs for medical support, lost working days and personal suffering of the workers developing allergic cement eczema. 

Table 1. Prevalences of irritant and allergic cement eczema. Cement workers exposed to mortar or concrete made from cement without the addition of ferrous sulfate...

Allergic cement eczema seems to be more severe than irritant cement eczema (see Chap. 71). Construction workers with allergic cement eczema have more frequent episodes of hand eczema and requirements for topical steroid treatment (Avnstorp 1989a). The persistence of allergic cement eczema is not solely caused by exposure to Cr(VI). It is, in part, also associated with daily irritation of the skin by wet cement. If a worker is advised to change occupation or to be retrained, it is therefore essential that the new job should not involve contact with abrasive wet work processes or contact with other irritants such as, for example, cutting oils. 

In Switzerland, construction workers with a declaration of medical inability are not allowed to perform any further work with contact to Cr(VI) or cement. Of a group of construction workers with allergic cement eczema, 72% (63 of 88) healed in the first few years, following strict avoidance of contact with cement and chromium salts (Lips et al. 1996). 

Among 360 construction workers in Singapore, 3 workers with allergic cement eczema, took five periods of sickness absence due to their hand eczema in 1 year. The total number of lost working days was 53 days. It was concluded that the number of workers requiring sick leave due to occupational dermatoses was low, but that those with the condition required about 2 weeks of leave. Furthermore, allergic cement eczema was the only type of occupational dermatosis causing sickness absence in this factory (Goh 1986). 

Environment and health-related problems Water-soluble chrome(VI) compounds in the wet cement or mortar have a highly sensitising effect and are up to 90% the cause of allergic cement dermatitis (cement eczema, bricklayer s itch ). The high alkalinity (pH = 13) of cement aids the development of this contact eczema. Bricklayer s itch is one of the most frequent professional diseases in the construction industry. 

Cement eczema may be of an irritant nature, allergic or both. 

Most data do not separate cement eczema into subgroups of allergic and irritant. Exact prevalences might therefore be difficult to give. Another problem in the interpretation of data concerning prevalences and incidences is due to the fact that most data are obtained from patch-test clinics. This may give inaccurate information due to selection bias. Studies carried out at work sites provide more accurate epidemiological information. 

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