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Dermatitis and other skin disorders.
Workers who are exposed to portland cement and portland cement containing products can get occupational skin disease. The occupational skin disease can include irritation, irritant contact dermatitis, allergic contact dermatitis and caustic burns. |
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Cement is caustic and prolonged contact with wet cement will cause skin irritation and burns. Cement contains hexavalent chromium, which causes allergic dermatitis. Other masonry materials are abrasive and irritating to the skin, and increase the likelihood of developing an allergy.
The skin is the single largest organ. It covers 20 square feet of surface. The skin's purpose is to protect the body from outside substances, chemicals, and bacteria. The skin has two layers. Together both are less than 1/8-inch thick. The epidermis (outer layer) is only 1/250th of an inch thick. The dermis is only 1/50th to 3/25ths of an inch thick.
Worksite materials can cause skin problems. Some materials ‘insult’ and injure skin. Some pass through it into the bloodstream. Examples of these materials are:
Portland cement is very alkaline (caustic) when wet so it affects skin surface pH. Cement is hygroscopic so it draws moisture from skin. Cement products are abrasive and physically damage the skin surface, making it a less effective barrier against chemicals. The moisture in eyes, mucous, and sweaty or damp skin can activate dry cement, making it caustic. These factors allow cement to cause dry skin and irritant contact dermatitis.
Sensitizers in workplace materials may cause an allergic response. The reaction may be local or widespread. Sensitization is an immune response. The immune system fights a foreign substance. Usually, the material causes no change on first contact. Once a person is sensitized, small amounts can trigger a strong reaction. Many people cannot tolerate further exposure.
Possible sensitizers used by construction workers include: hexavalent chromium (Cr6+ ) in cement, chemical admixtures in concrete, epoxies, additives in rubber gloves, and other trace metals in cement products.
Hexavalent chromium (Cr6+) is a sensitizer. It is an important cause of allergic contact dermatitis. Cement’s alkalinity increases skin absorption of this soluble chromate. Some studies show that Cr6+ penetrates the skin and enters the bloodstream.
Worksite cleaners too often are caustic and abrasive. They also may contain sensitizers like lanolin, limonene, or perfume and irritants like alcohol.
Worksite conditions can determine whether a worksite material will cause skin problems.
- How long does the material contact the skin?
- How often does a worker use the material?
- Is there mechanical trauma or abrasion of the skin (a break in the barrier)?
- Is the material trapped or occluded to the skin with gloves, creams, lotions, petroleum jelly, or barrier creams?
- Are there adequate hygiene facilities?
Environmental factors can cause skin problems directly or they can work with other factors to increase skin problems:
- Heat causes sweating. Sweat dissolves chemicals and brings them into closer contact with the skin. Heat increases blood flow at the skin surface and increases absorption of materials into and through the skin.
- Cold dries the skin and causes microscopic cracks. Cold changes blood flow at the skin surface and leads to loss of feeling.
- Humidity increases sweating. High humidity keeps sweat from evaporating. Extremely low humidity can dry skin as sweat evaporates.
- Sun burns and damages skin. Sun can increase absorption of chemicals. Sun reacts with some chemicals to cause photosensitization.
Individual factors can affect work-related skin problems. These include:
- pre-existing dermatitis
- genetic predisposition
- knowledge
- attitude
- personal behavior/work practices
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Exposures are of such a magnitude and character that a significant number of workers risk developing serious long or short term health effects.
There are no studies that tell us how many masons have allergic dermatitis, or how many will develop it in any given year (incidence), in the United States. We do have some information from workers compensation claims, but the true rate of dermatitis is certainly higher that the number of dermatitis claims to workers compensation, for research has shown that most occupational diseases are under-reported. In Oregon between 1990 and 1997 the claim rate to workers compensation was 7/100,000 construction workers, and a study from Germany found a similar incidence. A study in Finland found that almost 9% of concrete prefabrication workers had work-related hand dermatitis. Among construction workers with skin problems 65% of the dermatitis was caused by work, with 40% being allergic to chromium, 10% to nickel, and 7.5% to epoxy resins in one study. In the German study noted above, the incidence of dermatitis among tile setters and terrazzo workers was 10 times that of a low risk construction occupation.
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Important tools you can use to measure the risk for dermatitis include:
- Observations and reports of work/personal practices
- Symptoms checklist
- pH tests of surface skin
Here are some tools you can use to measure the risk for dermatitis, and find ways to reduce the risk. You might also think of other tools.
- Observations and reports of work/personal practices
- Symptoms checklist
- pH tests of surface skin
Consider comparing your group of workers with themselves before and after beginning a program to reduce dermatitis (see solutions). Use written checklists. Watch your employees work and take reports from them of what they do to are compare a group before and after. Which best practices are the employees currently doing? Which are they failing to do? Keep a written record of observations. Have employees complete a symptoms checklist of the skin problems they currently have, with no names attached. Ask them to do a pH test of surface skin. Once you have a baseline record, then begin the effort to reduce skin problems. Take the same measurements periodically to assess progress. The results can help you adjust the efforts.
Best Practices Checklist
| ___ 1. Wash with clean running water and pH-neutral soap. |
| ___ 2. Wear correct gloves. |
| ___ 3. Wash before putting on gloves. |
| ___ 4. Wash again whenever gloves are removed. |
| ___ 5. Use disposable gloves or clean reusable gloves daily. |
| ___ 6. Remove gloves properly. |
| ___ 7. Wear glove liners. |
| ___ 8. No jewelry at work. |
| ___ 9. Long sleeves buttoned or taped inside gloves. |
| ___ 10. Rubber boots with pants taped inside for concrete work. |
| ___ 11. Never let cement remain on skin or clothes. |
| ___ 12. Avoid barrier creams |
| ___ 13. Avoid skin softening products at work. |
| ___ 14. Change out of work clothes before leaving jobsite. |
| ___ 15. See a doctor for any persistent skin problem |
Symptoms Checklist
| ___ 1. |
Check if you had at least one skin problem during the last 12 months |
| ___ 2. |
Check if you currently have the skin problem. |
| ___ 3. |
If you have a skin problem, check all the words that apply |
| |
| ___ redness |
| ___ burning |
| ___ blisters |
| ___ fissures |
| ___ oozing |
| ___ bumps/papules |
| ___ scaling or peeling or dead skin |
| ___ other (describe): |
| ___ stinging |
| ___ pain |
| ___ itching |
| ___ bleeding |
| ___ rash |
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SURFACE SKIN pH TESTING
| Palm |
pH ___ |
Palm |
pH ___ |
| Between Fingers |
pH ___ |
Between Fingers |
pH ___ |
| Back of Hand |
pH ___ |
Back of Hand |
pH ___ |
| Date |
______ |
Date |
_____ |
pH indicator papers make it easy to get reasonably accurate measurement of pH on skin surfaces, car interior surfaces, and other places. To test skin or dry surfaces, moisten the indicator in distilled water. Then apply it to the test surface. To test a liquid, dip the indicator in the liquid. Full range indicator papers (pH 1 to 14) work best for cement.
Normal skin is pH 4.5 to 5.5, meaning it is moderately acidic. Contact with wet cement changes skin pH to alkaline. At alkaline pH, skin barrier repair is slowed, damage is prolonged, and skin problems are worsened. Testing skin pH will help determine if the worker or workers are at risk for contact dermatitis. |
| References |
An Employer's Guide to Skin Protection
NIOSH Skin Page |
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Federal OSHA Standards
are enforced by the U.S. Department of Labor in 28 states. There are currently
22 States and jurisdictions operating complete State plans
(covering both the private sector and State and local government employees)
and 4 — Connecticut, New Jersey, New York and the Virgin Islands — which cover public employees only.
California,
Oregon, and
Washington, have complete standards for
construction.
Michigan,
Minnesota,
Maryland,
Virginia and
Kentucky
have amended some OSHA standards and have added requirements not included in Federal rules.
Puerto Rico
has a Spanish translation of Federal standards. If you are working in one of those states
you should ensure that you are complying with all state requirements. The remaining state plan states have adopted
and enforce the federal OSHA standards as written.
Regulations adopted by a state must be at least as protective as the corresponding federal standard. Work may also be
subject to rules of other federal, state and local agencies. Even where there is no hazard specific standard, OSHA
prohibits employers from to work in surroundings or under working conditions which are unsanitary, hazardous, or
dangerous to his health or safety.
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