Irritant construction workers

The effect of decreasing the concentration of water-soluble chromium in cement from about 10 to below 2 ppm on the incidences of chromium-induced dermatitis was examined among construction workers in Finland (Roto et al. 1996). After 1987, when the decrease occurred, allergic dermatitis caused by chromium in the industry was reduced by 33% from previous levels, whereas irritant contact dermatitis remained unchanged. 

Seidenari S (1996) Skin sensitivity, interindividual factors atopy. In van der Valk PGM, Maibach HI (eds) The irritant contact dermatitis syndrome. CRC, New York, pp 267-277 Singgih SI, Lantingha H, Nater JP, Woest TE, Kruyt-Gaspersz JA (1986) Occupational hand dermatoses in hospital cleaning personnel. Contact Dermatitis 14 14-19 Skogstad M, Levy F (1994) Occupational irritant contact dermatitis and fungal infection in construction workers. Contact Dermatitis 31 28-30... 

While Burrows, in 1972, reported that 79% of patients with occupational contact dermatitis fol-lowed-up over 10-13 years still require treatment for their dermatitis (Burrows 1972), a report from Singapore showed total clearance of dermatitis in 72% of their patients after a i-year follow-up. In Sydney, Rosen et al. reported that improvement of occupational contact dermatitis occurred in 74% and 68% of patients with occupational irritant and allergic contact dermatitis followed up over 2-10 years, respectively (Rosen and Freeman 1993). In the United States, Nethercott et al. reported that 63% of workers had clearance of their occupational contact dermatitis when foUowed-up over a 4-year period, and when patients with mild eczema were included, the improvement rate was 81%. In a recent report form Switzerland, where the medical records of 88 construction workers who had occupational dichromate dermatitis... 

Construction workers risk occupational contact dermatitis from exposure to irritants, chromate, cobalt, rubber and epoxy. Nickel allergy, however, is not often discussed in relation to construction work (Coenraads et al. 1984). In construction workers it is often found together with allergy to chromate and/or cobalt, and nickel in cement has been proposed as a cause. However, nickel in cement exists mainly as insoluble salts (Wahlberg et al. 1977 Goh et al. 1986). 

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. 

Skogstad M, Levy F (1994) Occupational irritant contact dermatitis and fungal infection in construction workers. Contact Dermatitis 31 28-30... 

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. 

Table 1. Prevalences of irritant and allergic cement eczema construction workers who are exposed to concrete made from cement without the addition of ferrous sulfate...

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). 

Ocular Effects. Ocular effects can occur as a result of direct contact of eyes with chromium compounds. These include corneal vesication in a man who got a drop or a crystal of potassium dichromate in his eye (Thomson 1903) and congestion of the conjunctiva, discharge, corneal scar, and burns in chromate production workers as a result of accidental splashes (PHS 1953). Higher incidences of subjective complaints of eye irritation were reported by housewives who lived near a chromium slag construction site than by controls (Greater Tokyo Bureau of Hygiene 1989). 

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