Irritant cement eczema

Avnstorp C (1996) Irritant cement eczema. In van der Valk PGM, Maibach HI (eds) The irritant contact dermatitis syndrome. CRC, New York, pp 111-119... 

Depending on exposure, concentration and time, and individual factors, different clinical manifestations of irritant cement eczema are seen (Avnstorp 1995). 

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). 

Age may influence the development of irritant cement eczema. Workers in the age group of 26-30 years are more affected by the irritant properties of cement (Geiser and Girard 1965). The reason may be that younger, inexperienced workers tend to be more careless and, thereby, are more frequently exposed (Goh et al. 1986). 

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). 

The dynamics of the development of occupational hand eczema are not fully understood, but irritation and contact sensitivity, together with individual constitutional factors, influence its development. Theoretically, at least one of the triggering factors could be eliminated if the workers used individual preventive measures. Use of gloves, protective hand creams and hand washing were not found to influence the propensity for developing irritant cement eczema (Avnstorp 1991). Furthermore, no additional effect was found from individual preventive measures. The absence of influence from individual preventive measures could be explained by the possibility that the work processes are so hazardous that they overwhelm the protective effect. It could also be that the preventive initiatives were not conducted systematically or carefully enough. 

Hevding 1970). In Sweden, 3% (3 of 100) of bricklayers had irritant cement eczema (Wahlberg 1968). In the Netherlands, 6.4% (23 of 357) of bricklayers and concrete workers had the same condition (Coenraads... 

A few studies are made on the work sites, thereby giving valid data (Table 1). In Norway, the prevalence of irritant cement eczema among bricklayers and bricklayers assistants was found to be 1.2% (4 of 333)... 

Daily exposure to cement products may influence the course of irritant cement eczema. In a study among retired bricklayers, only 4 of 113 were found to have chronic hand eczema. Among younger unemployed bricklayers, the prevalence of cement eczema was 1.7% (2 of 121) in contrast with the prevalence of 6.4% (24 of 370) among those who were employed (Avnstorp 1995). 

The incidence of irritant cement eczema was stable and without influence from exposure time among workers with more than 6 years of exposure (Avnstorp 1991). In a follow-up study among workers from the prefabricated concrete industry, the incidence was found to be 9.8% (12 of 122). A diagnosis of irritant cement eczema was made if the worker had experienced hand eczema lasting for at least 2 weeks within the past year (Avnstorp 1989a). 

Irritant cement eczema has a relatively short duration and a relatively good medical prognosis. In a follow-up study of construction workers, 2 of 11 workers with irritant cement eczema developed chronic hand eczema within a 6-year period. Ten of the 11 workers were still employed at the factories one worker had retired. The eczema of eight of the workers had cleared up, although they stayed in the same occupation (Avnstorp 1989a). 

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 Denmark, very few workers took sick leave due to irritant cement eczema. Among 122 construction workers, only one had taken sick leave due to irritant cement eczema within the past 12 months. In the same period, three had consulted a dermatologist and four had used topical steroid treatment. Twelve workers with irritant cement eczema did not change occupation, became unemployed or took early retirement more often than expected for the whole group of workers (Avnstorp 1989a). 

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

The prognosis of contact dermatitis is unfavourable in the construction industry. In an Australian study, 54.5% of construction workers suffering from hand dermatitis showed no improvement over a 6-year follow-up between 1984 and 1990, and this included the people leaving the industry (Rosen and Freeman 1993). This may be due to difficulties in avoiding contact with irritants and allergens, especially chromates, or due to the tendency of cement eczema to become chronic. Atopies had a worse prognosis than the non-atopics. 

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...

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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