What is the appropriate treatment for cement-related skin dermatitis?

Treatment of Cement-Related Skin Dermatitis

Complete avoidance of cement exposure combined with mid-to-high potency topical corticosteroids and aggressive emollient therapy is the cornerstone of treatment for cement dermatitis. 1, 2

Immediate Management Steps

Allergen and Irritant Avoidance

• Stop all direct cement contact immediately – cement causes both irritant dermatitis (from high alkalinity) and allergic contact dermatitis (from hexavalent chromium/chromate content). 3, 4
• Replace all soaps and detergents with emollients, as these are universal irritants that perpetuate inflammation even after cement exposure has ceased. 1, 2
• Wash affected areas with gentle cleansers (pH-neutral synthetic detergents preferred over soap) and lukewarm water only – avoid hot water as temperatures >40°C increase skin permeability and worsen dermatitis. 1, 2

Topical Corticosteroid Therapy

• Apply triamcinolone 0.1% twice daily for localized disease as first-line treatment. 5
• For severe or extensive involvement, escalate to clobetasol propionate 0.05% twice daily for up to 2 weeks maximum – this super-high potency steroid should not exceed 50g per week total use. 6
• Discontinue corticosteroids once control is achieved; if no improvement within 2 weeks, reassess diagnosis and consider patch testing. 6

Aggressive Moisturization Protocol

• Apply 2 fingertip units of fragrance-free moisturizer (containing petrolatum or mineral oil) immediately after each hand washing, reapplying every 3-4 hours. 2, 5
• Use the "soak-and-smear" technique: soak affected areas in plain water for 20 minutes, then immediately apply moisturizer to damp skin nightly for up to 2 weeks. 2, 5
• Prefer moisturizers packaged in tubes rather than jars to prevent contamination. 2

Diagnostic Workup

Patch Testing

• Refer for patch testing with an extended standard series including potassium dichromate if dermatitis persists despite 2 weeks of appropriate treatment or if allergic contact dermatitis is suspected. 1, 2, 3
• All cement workers with dermatitis should be tested for chromate (potassium dichromate) and amine additives, as both are common sensitizers in concrete products. 7
• Avoid systemic corticosteroids >10mg prednisolone daily and potent topical steroids to the back within 2 days before patch testing, as these cause false negatives. 1, 2

Clinical Distinction

• Pattern and morphology alone cannot reliably distinguish irritant from allergic cement dermatitis – both can present with dry, fissured skin, hyperkeratotic papules, erythema, or acute exudative eczematous lesions on hands and fingers. 1, 3
• Cement burns (severe acute irritant contact dermatitis) present as necrotic ulcers following prolonged contact with wet cement, typically on legs/feet inside boots, and patch testing for chromate is negative. 3, 8

Protective Measures During Ongoing Exposure

Glove Selection and Use

• Use rubber or PVC gloves with cotton liners for cement handling, removing them regularly to prevent sweat accumulation which aggravates dermatitis. 1, 2
• Select gloves based on specific chemical exposures and check Material Safety Data Sheets for permeation times – no glove is completely impermeable to cement constituents. 1, 2
• Apply moisturizer before donning gloves to reduce occlusion-related irritation. 2
• Current protective clothing and gloves used at construction worksites often fail to thoroughly protect skin – better protective equipment and improved working conditions are essential. 3

Barrier Creams

• Do not rely solely on barrier creams – they have questionable clinical value in cement exposure and may create false security, reducing implementation of appropriate preventive measures. 1, 2
• After-work creams have demonstrated benefit in reducing irritant contact dermatitis incidence and should be readily available. 2

Second-Line Therapies for Refractory Cases

When First-Line Treatment Fails

• Consider topical tacrolimus 0.1% where topical steroids are unsuitable, ineffective, or when chronic dermatitis raises concerns about steroid-induced skin damage. 1, 2, 9
• PUVA (psoralen plus UVA) phototherapy is an established second-line treatment for chronic cement dermatitis resistant to topical steroids, supported by prospective clinical trials. 1, 2
• For severe chronic hand eczema from cement, offer alitretinoin (strong recommendation). 1, 2

Systemic Immunosuppressants

• Consider methotrexate, mycophenolate mofetil, azathioprine, or ciclosporin for steroid-resistant chronic cement dermatitis. 2
• Dupilumab has shown success in severe chromate-induced allergic contact dermatitis refractory to ultra-high potency topical corticosteroids, offering an alternative when other treatments fail. 9

Occupational Considerations

Workplace Assessment

• Arrange workplace visits to identify hidden cement exposures, assess procedures causing accidental contact, and review Material Safety Data Sheets – this is essential for effective treatment and prevention. 1, 2
• Implement comprehensive educational programs for workers, which demonstrate improvements in established dermatitis and prevention of new cases. 2
• Compliance with skin-protection programs is often poor among construction workers, requiring ongoing reinforcement. 2

Prognosis and Job Modification

• The long-term prognosis for occupational cement dermatitis is poor: only 25% achieve complete healing over 10 years, 50% have intermittent symptoms, and 25% have permanent symptoms. 1, 2
• Changing occupation does not improve prognosis in 40% of cases, emphasizing the critical importance of early intervention and complete allergen avoidance. 1, 2
• Most cement-related skin diseases occur among workers at small-scale enterprises – regional occupational health centers should take prompt measures to prevent these conditions. 3

Critical Pitfalls to Avoid

• Do not wash hands with dish detergent or other harsh cleansers – these worsen barrier dysfunction. 2
• Avoid very hot or very cold water for washing affected areas. 2
• Do not use disinfectant wipes on skin – these contain harsh antimicrobials designed for surfaces. 2
• Avoid topical antibiotics (neomycin, bacitracin) without clear indication, as they are frequent contact allergens. 2
• Do not apply moisturizers, gels, or dressings shortly before corticosteroid application, as this may interfere with drug penetration. 1
• Prolonged occlusion by gloves without underlying moisturizer application should be avoided, as occlusion itself may impair stratum corneum barrier function. 1, 10

Special Considerations

Chromate Legislation

• Despite legislation regulating hexavalent chromium content in cement, chromate contact allergy can still be found in concrete workers – initiatives to reduce chromium content have decreased but not eliminated allergic dermatitis. 4, 7
• The irritant form of cement dermatitis remains common even with reduced chromium content. 4

Amine Additives

• Occupational contact allergy to amines (including ethylenediamine) can occur in workers exposed to cement and concrete – these additives should be included in patch testing for cement workers. 7