Treatment of Chemical Burns from Cement
Immediately irrigate the affected area with copious running water for at least 15 minutes, remove all contaminated clothing and jewelry, and arrange urgent evaluation by a burn specialist, as cement causes progressive alkali burns that can result in full-thickness injury even with delayed symptoms. 1, 2, 3
Immediate Decontamination (Critical First Step)
For cement burns specifically, brush off any dry cement powder before water irrigation to prevent exothermic reaction and additional injury. 1, 2 Cement is an alkali that causes progressive chemical burns through liquefaction necrosis, and the injury continues until the chemical is completely removed. 3, 4
Continue irrigation for at least 15 minutes with clean running water, and extend irrigation time if pain persists or the burn area is extensive. 1, 2 The American Heart Association emphasizes that immediate irrigation within 3 minutes of exposure significantly reduces full-thickness burns and complications compared to delayed treatment. 2
Remove all contaminated clothing, shoes, and jewelry immediately to prevent cement from being trapped against the skin, which allows continued chemical contact and deeper burns. 1, 2 This is particularly critical with cement burns as workers often don't recognize the injury until hours later when cement has dried inside boots or under clothing. 3, 4
Use personal protective equipment when providing care to avoid contaminating yourself with the alkaline cement. 1
Critical Recognition and Pitfalls
Cement burns are frequently underestimated and unrecognized because initial symptoms may be minimal, but they can progress to severe full-thickness burns over hours. 3, 4 This delayed presentation is a major clinical pitfall—the lack of immediate pain does not indicate absence of serious injury. 4
Contact emergency medical services and a burn specialist immediately for any significant cement exposure, as early surgical evaluation is necessary. 3 One case series documented that serious morbidity occurs from unrecognized cement burns, and early decontamination with burn surgeon evaluation prevented adverse outcomes. 3
Never assume the injury is minor based on initial appearance—cement's alkaline pH (12-13) causes progressive tissue destruction that worsens over time. 4
Post-Decontamination Wound Care
After thorough irrigation:
Cover the burn loosely with a clean, non-adherent dressing to reduce pain, protect from contamination, and limit heat loss. 2, 5
Administer over-the-counter analgesics (acetaminophen or NSAIDs) for pain control, as these are well-tolerated and effective for burn pain. 5
For small partial-thickness burns being managed at home after specialist evaluation, it may be reasonable to apply petrolatum or petrolatum-based antibiotic ointment and a clean non-adherent dressing after cooling. 5
Avoid silver sulfadiazine for superficial burns, as it is associated with prolonged healing when used long-term on superficial injuries. 2
Specialized Considerations for Cement Burns
High-pressure cement injection injuries require immediate surgical debridement for decompression and minimization of chemical burn. 6 These injuries have the same urgency as other high-pressure injection injuries but with added complexity from cement's chemical properties. 6
Serial radiographs may be necessary to guide debridements and ensure complete removal of all cement fragments, as hardened cement visible on x-ray must be completely removed. 6
Consider early excision and skin grafting for deep cement burns, as this approach significantly reduces morbidity and hospital length of stay. 7
When to Transfer to Burn Center
Arrange immediate transfer to a specialized burn center for: 5, 7
- Burns involving face, hands, feet, or genitals
- Second- or third-degree burns covering >10% body surface area (>5% in children)
- Full-thickness burns
- Any concern for deep or extensive cement exposure
Specialized burn centers significantly improve survival, reduce morbidity, and enable earlier surgical intervention. 7
What NOT to Do
- Never delay irrigation to search for neutralizing agents—water irrigation must begin immediately. 2
- Never apply ice directly to burns, as this causes additional tissue damage. 2, 7
- Never apply butter, oils, or home remedies to burn wounds. 2, 7
- Never break intact blisters, as this increases infection risk. 2, 7
Follow-Up Monitoring
- Monitor daily for signs of infection: increased pain, erythema extending beyond burn margins, swelling, or purulent discharge. 7
- Do not use systemic antibiotics prophylactically; reserve for clinically evident infections. 7
- Recognize that cement burns often require multiple debridements due to progressive tissue necrosis and the need to remove all cement material. 6, 8