Four months ago, my parents gave me an Apple Watch for my 30th birthday. Though I was never a “watch guy” before this, I strapped on that thing and, almost literally, have not taken it off since. The only time I remove the smartwatch is to charge it while I do the dishes or shower, even though the watch is waterproof. And while many watch-wearers might take off their watch to go to bed, I’ve become obsessed with tracking the data of my day-to-day vital signs — how well I sleep, my heart rate before, during and after a workout, and everything in between. I would take it off, but those gaps of data in my health app feel so staggering, I feel the need to wear it all the time.
So it was no surprise when I happened to catch a whiff of my wrist and notice a weird smell.
Not only that, but the skin below the watch face looked a little wrinkled and red.
This can’t be good, I thought.
A quick internet search found that others are going through a similar problem.
So what’s happening here?
Dermatologist Dr. Erum Ilyas tells MEL this has always been an issue with people wearing things like rings and watches too much, but it’s becoming a very common issue thanks to fitness trackers. She and another dermatologist, Dr. Fayne Frey, explain all the things that can go wrong when you become so obsessed with tracking your vitals you never take your watch off.
The Soap Residue Problem
Dr. Frey explains the first and most common issue people find when they never take their watches off: a buildup of moisture beneath the skin.
“The problem with the Apple Watch is that people wear them fairly tight because they want to take their pulse and vitals, so they’re pretty snug on the skin and worn for long periods of time,” she tells MEL.
This leads to what dermatologists call maceration, or MASD — moisture-associated skin damage. According to Dr. Frey, water is always evaporating out of our skin, but a tight watch band will prevent that evaporation from happening. With potential sweat dripping between the watch and your wrist, along with water from the shower or elsewhere, the skin on your wrist becomes oversaturated.
Maceration Is Self-Abuse
“First you’ll get some wrinkling,” Frey explains, “which is the maceration effect from too much water being trapped and unable to evaporate from your arm. It’s a white-ish-looking, wrinkled, wet skin.”
Basically, she continues, your skin is eroding “from long exposure to a source of moisture,” the same thing that happens to babies with diaper rash, or elderly people with incontinence.
Beyond the damage water alone can do to your wrist, Dr. Ilyas adds, the maceration effect can be compounded by soap residue. “If water and soap build up between a watch or other jewelry item and the skin, the result will be the beginnings of skin breakdown,” she explains.
Essentially, the hydrophobic soap molecules burrow deeper into your skin, away from moisture, and “emulsifies the fats and lipids in the superficial layers of skin.”
She continues: “This turns the skin white and macerated and appears wrinkly. If the skin is not addressed at this point, dead skin cells start to accumulate and the keratin can start to smell — kinda like the cheesy white stuff that comes out of a cyst or a pimple.”
Depending on how tightly you wear your watch, how much you sweat and if you shower with your watch on, Frey says, maceration can develop over the course of a couple days.
“Some people shower with [smartwatches on], so it’s exacerbated by that,” she says. “And then there are other factors that make it even worse, like friction. So a combination of the friction and water not evaporating, along with maybe an overgrowth of some microorganisms on the skin — put all that together and you get an increased moisturization of the skin, which can cause a rash.”
Solution? Just take your watch off. It’s as simple as that. “I’d recommend removing the watch until the skin is back to normal,” Frey says, adding that if your skin is starting to look particularly white and wrinkly, you might need to leave it off for a couple days. “That could take days or several weeks depending on how bad the initial insult was.”
Dr. Ilyas also recommends making sure your wrist and watch are completely dry before putting it back on.
Beyond that, Frey recommends seeking medical attention if your “skin becomes red, painful or doesn’t improve after several days,” signs that an infection has set in.
If you’re not obsessively wearing your watch 23.9 hours a day and still develop a rash, you might be allergic to something either in the watch face or band.
In the watch backing and bands, there’s often “nickel and rubber,” which “some people are allergic to,” Dr. Ilyas tells MEL. “Initially, [this allergic reaction] would appear as a red itchy rash as opposed to skin wrinkling and breakdown.”
Tracking-device manufacturers are acutely aware of the allergy issue. In 2014, Fitbit issued a recall of its Force band after 1.7 percent of users developed skin rashes. In 2017, Apple ran artificial sweat tests in its lab to measure what effect moisture had on nickel exposure.
“Up to 20 percent of women are allergic to nickel,” Dr. Frey tells MEL. “So it depends on where the allergy is — if it’s in the band or if it’s on the back of the head of the watch, which is usually some sort of metal composite.”
She adds, “If you’re allergic to the nickel, you might sweat or it might get a little wet, which allows the nickel to ooze out onto the skin — and then you get some sort of allergic reaction.”
Is There a Solution?
Dr. Frey says she sees more cases of nickel allergy in her clinic than she does maceration. “When people start seeing an inflammation under the band, they realize it’s from the band and take it off before it becomes an issue, but it’s not always so obvious with [allergies]: They don’t understand why a rash is happening under the back of the watch.”
On Reddit, some users recommend putting clear tape or nail polish on the back of the watch head, which Dr. Frey says is only a temporary solution.
“They’re trying to create a barrier from the allergen — the nickel — to the skin, but ultimately, over time, it wears through. It’s not a permanent fix, but it is an attempt, and that wouldn’t help maceration, just the allergy,” she explains.
“If it’s an allergy, then you solve the problem with an anti-inflammatory, like a cortisone. If it’s an irritant, same thing. If it’s inflamed, use a cortisone or an antibiotic,” she says, pointing out that Apple has taken special lengths to address what’s in the Apple Watch and how to wear and clean it. (I totally missed all that — oops.)
Overall, Frey concludes, just stop wearing your tracking devices all the time, and don’t strap them on so tightly it prevents moisture from naturally leaving your skin. No matter how badly you might want to track your sleep and heart rate 24/7, she says, for the sake of your skin, “take it off at night, and don’t wear it in the shower — those are the big ones.”