Cement burn

Background

• Widely used in construction, under recognized as a caustic agent able to cause severe skin injury
• Calcium hydroxide very strong corrosive alkali
• pH of 10-12 that can increase to pH 14 during hydrolysis/setting process

Clinical Features

• Most often on lower legs/knees given nature of work
  • Kneeling down in cement, walking in cement without protection, spilling over top of work boots
• Symptom onset several hours after exposure - may not start to feel until 3-4 hours after initial exposure
• Can have partial to full thickness burn

Differential Diagnosis

• Lye Burn

Caustic Burns

• Caustic ingestion
• Caustic eye exposure (Caustic keratoconjunctivitis)
• Caustic dermal burn
• Airbag-related burns
• Hydrofluoric acid
• Tar burn
• Cement burn

Evaluation

• Causes a liquefactive necrosis via protein denaturation (not a thermal burn)

Management

• Copious water irrigation for at least 30 mins
• May cause circumferential burns
• Counsel about skin protection in future if occupational

Disposition

• As can look benign in first few hours, admission, may need burn center if full thickness, circumferential, involving feet

Burn Center Transfer Criteria

• Partial thickness >20% BSA in 10-50
• Partial thickness >10% BSA in <10 or > 50 yrs old
• Full thickness >5% BSA in anyone
• Burns involving face, eyes, ears, genitalia, joints, hands, feet
• Burns complicated by confirmed inhalation injury
• High voltage burn
• Burns complicated by fracture or other trauma (in which burn is main cause of morbidity)
• Burns in high-risk patients

See Also

• Burns

References

• Spoo J, Elsner P. Cement burns: a review 1960-2000. Contact Dermatitis 2001; 45:68.

Authors

Hemang Acharya, Ross Donaldson, Neil Young