Medical mystery: A DIY disaster
Cement burns — chemical wounds that can result in devastating deformity or skin changes that take months and even years to heal — are an under-recognized but growing threat.
A 55-year-old man came to the urgent-care center in near-agony, severe sores rapidly progressing along his forearm. The skin burned a fiery red, with patches of pure white and dark black where deeper tissues had become involved.
The cause of these lesions was unclear. He’d been working outside for much of the day, but sun exposure didn’t appear to be the cause of his misery. He’d had no exposure to bugs, plants, or strong chemicals, he told us.
We kept asking questions and urged him to tell us everything he’d been doing, regardless of whether he thought it might matter.
He told us he liked to work around the house and tackled a project that involved a small amount of cement. It wasn’t enough to bother with renting a mixer, but he wanted to be sure it was well-combined. So he plunged his right hand and forearm in the container to give it a good stir.
How long, we asked, had any of the cement been on his skin?
Not quite an hour, came his answer.
With that reply, we had our answer, and knew that our patient had fallen prey to a problem that’s been rising steadily in the past couple decades, along with the DIY movement.
Solution:
Cement burns — chemical wounds that can result in devastating deformity or skin changes that take months and even years to heal — are an underrecognized but growing threat. While industrial exposure has fallen due to proper training in hazardous material management and occupational safeguards, household mishaps and homegrown projects continue to lead to what has been termed the “sneak attack” of cement burns.
Often affecting exposed and poorly protected extremities, cement burns cause a destructive liquefaction of skin and tissue. When water is added to commonly available cement preparations, it mixes to form calcium hydroxide, a strong and harmful base (similar to the lye found in household drain cleaners).
Unlike acids, which often lead to painful and dramatic tissue damage, bases tend to cause injuries that, without treatment, slowly but steadily worsen over time. Other components, such as sand or gravel, which give the material its classic consistency and strength, lead to abrasive injuries — microtears and cuts — that provide an opportunity for cement water to penetrate more deeply into tissue, and result in more skin damage.
Yet concrete burns remain underreported in the medical literature, and may be poorly recognized by lay people and medical personnel alike. Nearly all cases cause significant redness, burning, and skin erosions, and some patients may develop swelling or blistering. Little data exists on the optimal management; however, most resources and experts agree that early surgical evaluation and treatment — which may include skin grafting, excision, and debridement of severely damaged tissue, and in the most severe cases, even limb amputation — are critical for optimal healing.
Our patient ultimately required surgical debridement and skin grafting as a consequence of the damage caused from his cement burns.
Prevention and protection are essential whenever handling cement. Like any other powerful tools, such as saws, drills, or lawnmowers, proper precautions include knowing how to use cement properly and the safety gear required.
Waterproof gloves, long-sleeved clothing, knee pads, and eye protection are all essential. If cement — and especially cement water — does touch your skin, wash it off immediately with plenty of water, and monitor the area for pain, swelling, or redness. Remember that even clothing soaked in cement water can lead to burns, so take it off right away.
Recognize that cleaning buckets filled with concrete-covered tools will become progressively contaminated and caustic with the addition of more tools and materials. So you need to take the same precautions in cleaning up as you did in mixing and applying the cement.
If wet cement gets into the eyes, they should be rinsed with clean water and the injured person should be taken to the emergency department of the local hospital immediately.
Robert Kiser is an urgent-care physician of the department of family practice at Ascension Health. Maxwell Cooper is an associate program director of emergency medicine residency and director of emergency ultrasound at Crozer-Keystone Health System. Rick Pescatore is the medical director and director of clinical research in the department of emergency medicine at Crozer-Keystone Health System.