Physician's Alert: Skin Conditions
|
|
CPWR – Center for Construction Research and Training
This is
for a worker who works with cement to take to his/her doctor. |
The patient presenting
this pamphlet is a construction worker who has frequent occupational contact
with caustics, acids, and sensitizers.
Please keep this
information for reference in the patient's file to aid in evaluation of
possible skin conditions.
CPWR – Center for Construction Research and Training Silver Spring, MD
Your patient is a construction worker with exposure to wet cement.
Construction workers
are exposed to a number of chemicals known to cause irritant and allergic
dermatitis. Portland cement, found in plaster and in concrete mixes, is
extremely alkaline. Wet plaster also contains slaked lime, or calcium
hydroxide, which is even more caustic than Portland cement.
Further, Portland
cement contains trace amounts of hexavalent chromium. Hexavalent chromium
is a strong sensitizing agent responsible for allergic dermatitis in cement
workers around the world.
Other sensitizing
agents include various epoxy adhesives and sealants in addition to various
chemicals present in the admixtures used with cement and plaster.
Finally, construction
workers may use products such as lanolin creams or lotions to soften their
skin. Lanolin is a sensitizing agent. Some industrial hand cleaners contain
limonene, also a sensitizing agent. The rubber in rubber gloves also may
cause allergic dermatitis.
This pamphlet
contains a partial listing of skin disorders, potential etiologic agents,
and possible medical surveillance.
Please maintain
this in your patient's file. Sources of additional information about occupational
dermatitis are printed on the back.
Best Practices
A worker training
program teaches best practices for preventing occupational contact dermatitis,
including:
Wash hands
before putting on gloves |
|
Use a pH neutral
soap or cleaner |
|
Try to avoid
products with sensitizers, like lanolin or limonene |
|
Don't wear jewelry
at work |
|
If they can't
be left at the job, take work clothes home in a separate container.
Launder them separately |
|
See a physician
for a persistent skin problem, even a minor one. |
|
Anything you can
do to reinforce these behaviors is appreciated.
ADDITIONAL INFORMATION
For publications
and information on workplace hazards contributing to skin disorders contact:
NIOSH
Education and Information
Dissemination Division
Technical Information Branch
4676 Columbia Parkway
Cincinnati, OH 45226-1998
1-800-356-4674
CPWR
8484 Georgia Ave, Suite 1000,
Silver Spring, MD 20910
SKIN
DISORDERS |
ETIOLOGIC
AGENTS |
FINDINGS/SURVEILLANCE |
INTERVENTION
TREATMENT |
Xerosis
(dry skin) |
Alkalies;
abrasive cleaners; solvents; soaps; water; sun; heat; cold; low humidity. |
Dry
skin; scaling; itchiness; burning; redness |
Skin
exam and specific treatment; skin lubrication; change work practices;
protective clothing/equipment; gloves; mild soaps; temperature/humidity
control. |
Irritant
contact dermatitis (ICD) (acute, subacute, chronic) |
Portland
cement; plaster; lime; epoxies; solvents; other workplace products;
abrasive cleaners; alkaline soaps; hand/barrier creams; other personal
care products. |
Skin
exam; stinging; burning; pain; itching; blisters; dead skin; scabs;
scaling; fissures; redness; swelling; bumps, dry or with watery discharge;
usually concentrated where exposure occurs. Diagnostic aids: open
application tests; do not patch test to known irritants; do not patch
test to unknown chemicals. |
Skin
exam; skin lubrication; antibiotics for infections; astringent soaks;
topical or systemic corticosteroids; antihistamines; UV; wash hands
at least once before eating or leaving work for the day with pH neutral
cleaners; possibly add vinegar to neutralize alkaline wash/rinse water;
prevent exposure; proper gloves; long sleeves over gloves; remove
work clothes if soaked with wet plaster or epoxy. |
Allergic
contact dermatitis (ACD) (acute, subacute, chronic) |
Portland
cement; hexavalent chromium; other trace metals found in cement or
concrete; plaster; lime; epoxy resins, hardeners, reactive diluents;
some admixtures; lanolin; rubber; perfumes |
Skin
exam; stinging; burning; pain; itching; blisters; dead skin; scabs;
scaling; fissures; redness; swelling; bumps, dry or with watery discharge;
usually concentrated where exposure occurs, but also occurs on other
body parts; onset 2 to 7 days or more after exposure. Diagnostic
aids: open application tests; commercially available skin patch
tests (e.g. to some rubber, epoxy, and cement compounds); do not patch
test to known irritants; do not patch test to unknown chemicals. |
Skin
exam; skin lubrication; antibiotics for infections; astringent soaks;
topical or systemic corticosteroids; antihistamines; UV; wash hands
at least once before eating or leaving work for the day with pH neutral
cleaners; identify offending agent and prevent exposure; proper gloves;
long sleeves over gloves; remove work clothes if soaked with wet plaster
or epoxy. |
Cement/caustic
burns |
Portland
cement; lime; other alkalies; epoxy components. |
Blisters,
dead or hardened skin, black or green skin. |
Flush
with copious amounts of water; buffered solution to neutralize alkalies;
burn wound care; surgery; skin grafting; physical therapy. Cement
burns are alkali burns. They can progress and should be referred to
a specialist without delay. |
Caused
by mechanical trauma |
Friction;
pressure; pounding. |
Redness;
blisters; abrasions; thickening; discoloration; fissures; corns/callosities,
hives. |
Skin
exam and specific treatment; change work practices: use of proper
tools, protective clothing/equipment. |
Caused
by solar radiation, climate, temperature |
Sun;
heat; cold; sweat; low or high humidity. |
Burns;
dry skin; scaling; itchiness; burning; blisters; sweat pore blockage
(miliaria); maceration; frostbite; immersion foot; discoloration;
waxy skin; redness; swelling; tenderness; numbness; hives; gangrene. |
Skin
exam and specific treatment; sunscreens; change work practices: protective
clothing/equipment; temperature/humidity control. |
Contact
urticaria (hives) |
Latex;
rubber; epoxy resins; leather; clothing; cold; heat; sun; water |
Skin
exam; hives, swelling; redness; itchiness; pain; Diagnostic aids:
skin prick test; RAST tests; patch tests; Contact urticaria can
progress to include symptoms of nasal congestion, asthma, and rarely
anaphylaxis. |
Identify
and avoid offending agent; skin exam and treatment; antihistamines,
systemic corticosteroids. |
Visiting
the worker's jobsite or reviewing the Material Safety Data Sheets
of products used there may help to determine what substances the worker
is exposed to, the degree and duration of the exposure, the methods
and agents used to clean the skin, and the type of protective clothing
used. |
This
paper appears in the eLCOSH website with the permission of the author
and/or copyright holder and may not be reproduced without their consent.
eLCOSH is an information clearinghouse. eLCOSH and its sponsors are not
responsible for the accuracy of information provided on this web site,
nor for its use or misuse.
© Copyright 2000 CPWR – Center for Construction Research and Training. All rights
reserved. CPWR – Center for Construction Research and Training (CPWR) is a research arm
of the Building and Construction Trades Dept., AFL-CIO. (Edward C. Sullivan
is president of the Building and Construction Trades Department and CPWR.)
Production of this pamphlet was supported by a grant from the National
Institute for Occupational Safety and Health (NIOSH). The contents are
solely the responsibility of the authors and do not necessarily reflect
the official views of NIOSH. Developed by FOF Communications.
eLCOSH
| CDC | NIOSH
| Site Map | Search
| Links | Help
| Contact Us | Privacy Policy
|