What Are Keloid Scars? Raised Scar Growth, Causes & Treatment Options

Keloid scars are benign raised scars that keep growing beyond the edges of the original skin injury. They may follow piercings, acne, burns, cuts, surgery, tattoos, injections or inflammatory skin disease and may not become noticeable until weeks, months or occasionally years after the injury.

A keloid may feel firm, rubbery or hard and look smooth, shiny, skin-coloured, pink, red, purple, brown or darker than surrounding skin. It can itch, hurt or restrict movement. Treatment can flatten, soften and relieve symptoms, but no method guarantees complete permanent removal, so prevention and combination treatment are central.

How Can You Recognize a Keloid Scar?

A keloid is recognized by raised scar tissue that extends beyond the original wound boundary.

What Does a Keloid Look and Feel Like?

• Raised above the surrounding skin.
• Firm, rubbery or hard texture.
• Smooth or shiny surface.
• Rounded, irregular or claw-like shape.
• Growth into skin beyond the wound edges.
• Skin-coloured, pink, red, purple, brown or darker appearance.
• Gradual enlargement over months or years.
• Little tendency to flatten without treatment.

Which Symptoms Can a Keloid Cause?

• Itching or burning.
• Pain, tenderness or tingling.
• Hypersensitivity.
• Tightness or pressure discomfort.
• Clothing irritation.
• Restricted movement across a joint.
• Emotional distress related to visibility.

Where Do Keloids Commonly Develop?

• Earlobes and ear cartilage.
• Chest and breastbone.
• Shoulders and upper back.
• Jawline and beard area.
• Neck and cheeks.
• Upper arms.
• Sites of surgery, burns, acne or piercings.

Why Do Keloid Scars Keep Growing?

Keloids keep growing because wound-healing signals remain active and fibroblasts continue producing excess collagen.

How Does Normal Scar Formation Become a Keloid?

• An injury reaches the dermis.
• Inflammation clears damaged tissue.
• Fibroblasts produce collagen to repair the wound.
• Normal collagen production slows as healing finishes.
• In keloid-prone healing, inflammatory and growth signals persist.
• Fibroblasts continue adding collagen and extracellular matrix.
• Scar tissue extends beyond the original injury.
• Mechanical tension can keep stimulating growth.

Which Skin Injuries Can Trigger a Keloid?

• Ear or body piercing.
• Acne or chickenpox lesions.
• Folliculitis.
• Burns, cuts or abrasions.
• Insect bites.
• Tattoos.
• Vaccinations or injections.
• Surgery or caesarean-section wounds.
• Shaving inflammation or puncture wounds.

Inflammatory breakouts from acne can trigger keloids in susceptible people, especially on the jawline, chest, shoulders or upper back.

Repeated inflamed follicles from folliculitis can create dermal injury that heals with excessive scar growth.

Who Is More Likely to Develop Keloids?

• Previous personal keloid history.
• Close family history.
• Adolescence and early adulthood.
• Pregnancy-related hormonal change.
• Inherited susceptibility reported more often in darker naturally pigmented skin.
• African, Asian, Caribbean or Hispanic ancestry.
• High-tension wounds.
• Repeated inflammation or delayed healing.

Skin colour does not cause keloids. People of every skin tone can develop them, while inherited biology and wound conditions influence susceptibility.

How Are Keloids Different From Other Raised Scars and Skin Growths?

Keloids must be separated from hypertrophic scars, ordinary scars, follicular disorders and skin growths because management differs.

How Is a Keloid Different From a Hypertrophic Scar?

How Is a Keloid Different From an Ordinary Scar?

• An ordinary scar stays within the injury.
• It usually becomes flatter and paler during remodelling.
• It commonly softens with time.
• It does not continue growing into surrounding normal skin.
• A keloid generally persists and may keep enlarging.

Is Acne Keloidalis Nuchae a True Keloid?

• It develops along the back of the scalp and neck.
• It begins with inflamed hair follicles.
• It can create thick keloid-like plaques.
• It is not acne vulgaris.
• It is a follicular scarring disorder rather than a classic injury-induced keloid.
• Treatment must control follicular inflammation as well as scarring.

Can a Keloid Be Mistaken for Another Skin Growth?

• Dermatofibroma.
• Epidermal cyst.
• Foreign-body reaction.
• Piercing infection.
• Jewellery allergy.
• Dermatofibrosarcoma protuberans.
• Other benign or malignant skin tumours.

A firm small nodule may be a dermatofibroma rather than a scar, especially without a clear preceding injury.

A slowly enlarging lump with a central pore may suggest an epidermal cyst.

Itching or swelling that closely matches jewellery contact may reflect allergic contact dermatitis rather than true keloid overgrowth.

How Are Keloid Scars Diagnosed?

Keloids are usually diagnosed from the injury history, wound boundary, growth pattern, symptoms and appearance.

Which History Details Matter?

• Original injury or procedure.
• Delay between injury and scar growth.
• Whether the scar is still enlarging.
• Itching, pain or sensitivity.
• Previous keloids and family history.
• Prior treatments and recurrence.
• Piercing, tattoo, acne or surgery history.
• Effects on movement or daily activities.

What Does the Clinician Examine?

• Scar height, width and length.
• Extension beyond the original wound.
• Colour, firmness and flexibility.
• Surface ulceration or active inflammation.
• Joint restriction.
• Serial photographs or scar-rating scales.

When Is a Skin Biopsy Needed?

• No remembered preceding injury.
• Unusual growth pattern.
• Rapid enlargement.
• Ulceration or bleeding.
• Uncertain diagnosis.
• Possible tumour, infection or foreign-body reaction.
• Unexpected failure of scar treatment.

How Can New Keloid Scars Be Prevented?

The strongest prevention is avoiding unnecessary skin injury in people known to form keloids.

Which Procedures Should Keloid-Prone People Approach Carefully?

• Ear and body piercings.
• Tattoos.
• Cosmetic skin procedures.
• Elective surgery.
• Unnecessary injections.
• Scarification.
• Repeat procedures at a previous keloid site.

A strong personal or family history should be disclosed before any necessary procedure.

How Should a New Wound Be Cared For?

• Clean gently with soap and water or saline.
• Avoid unnecessary hydrogen peroxide, alcohol or iodine irritation.
• Maintain a moist healing environment with an appropriate dressing.
• Avoid scrubbing and repeated trauma.
• Change dressings as directed.
• Watch for early thickening.
• Protect healed skin from sunlight.

When Can Silicone Be Started?

• Begin only after the wound surface has closed.
• Do not apply to an open wound or active scab.
• Use consistently for months when advised.
• Monitor for irritation, moisture trapping or poor fit.
• Use preventively or after another keloid treatment.

How Can Keloids After Piercing or Surgery Be Reduced?

• Seek review when thickening first appears.
• Use pressure earrings for suitable ear lesions.
• Use silicone gel or sheets after closure.
• Consider preventive injections in selected high-risk wounds.
• Use pressure garments after selected burn or surgical care.
• Arrange close follow-up after necessary excision.
• Control acne and folliculitis early.

Which Non-Surgical Treatments Can Flatten a Keloid?

Non-surgical treatments aim to soften, flatten and relieve symptoms, often through repeated or combination therapy.

How Do Silicone Gel and Pressure Therapy Help?

• Silicone hydrates and softens the scar surface.
• It may reduce itch and limit further thickening.
• It can support recurrence prevention after procedures.
• Pressure devices compress scar tissue.
• Pressure earrings or garments can help ear or burn-related lesions.
• Consistent use over several months is often required.

How Do Corticosteroid Injections Treat Keloids?

• Medicine is injected directly into the scar.
• It reduces inflammation and collagen production.
• It can soften and flatten tissue.
• Pain and itching may improve.
• Several sessions are commonly required.
• It may be used alone or around surgery.

Possible effects include injection pain, skin thinning, indentation, visible small vessels, pigment change and rare ulceration.

When Are 5-Fluorouracil or Other Injected Medicines Used?

• 5-fluorouracil may be used alone or with corticosteroid.
• Other specialist agents can include bleomycin or verapamil.
• These treatments aim to reduce fibroblast activity or collagen production.
• They may be considered when corticosteroid alone is inadequate or poorly tolerated.
• Protocols vary and remain specialist-directed.

How Does Cryotherapy Treat Keloids?

• Freezing damages excessive scar tissue.
• Intralesional cryotherapy freezes from within.
• It is best suited to small or selected thicker keloids.
• Several sessions may be needed.
• It is often combined with injections.
• Risks include pain, blistering, ulceration, delayed healing and permanent light spots.

How Can Laser Treatment Help?

• Reduce redness and vascularity.
• Improve texture and pliability.
• Reduce scar height.
• Support delivery or effect of other treatments.
• Usually combine with injections or another method.
• Recurrence remains possible.

When Are Surgery and Radiation Used for Keloid Scars?

Surgery and radiation are reserved for selected keloids because removal creates a new wound that can trigger regrowth.

Why Is Surgery Alone Usually Avoided?

• Excision creates a new injury.
• The new wound can restart excessive collagen production.
• Regrowth may become larger than the original lesion.
• Recurrence after excision alone is very high.
• Surgery should usually be paired with recurrence-prevention treatment.

Which Treatments Can Be Combined With Surgery?

• Corticosteroid injections.
• 5-fluorouracil injections.
• Silicone gel or sheeting.
• Pressure earrings or garments.
• Cryotherapy or laser.
• Carefully planned wound closure.
• Selected postoperative radiation.

When Is Postoperative Radiation Considered?

• Large recurrent keloids.
• Lesions returning after several treatments.
• Anatomical sites with high recurrence.
• Cases where expected benefit justifies risk.
• Treatment by a specialist team soon after excision.
• Consent covering irritation, pigment change and long-term cancer concern.
• Not routine first-line care.

How Are Ear Keloids Commonly Treated?

• Corticosteroid injections.
• Surgical removal when indicated.
• Pressure earrings.
• Silicone.
• Cryotherapy or laser.
• Selected postoperative radiation for recurrent lesions.

What Results Can Be Expected From Keloid Treatment?

Treatment can improve symptoms and appearance, but complete permanent removal is not guaranteed.

Can a Keloid Be Completely Removed?

• Treatment can flatten and soften a keloid.
• Pain and itching may improve before appearance changes.
• Pigment may remain different from surrounding skin.
• Complete disappearance is not assured.
• Combination treatment generally works better than one method alone.
• Some lesions require repeated courses.

Why Do Keloids Return After Treatment?

• Biological susceptibility remains.
• Treatment can create new skin injury.
• Active scar tissue may remain.
• Skin tension can continue stimulating growth.
• Silicone or pressure may be stopped too early.
• Maintenance or follow-up treatment may be incomplete.
• New acne, folliculitis or piercing trauma can create new lesions.

How Long Does Treatment Take?

• Silicone and pressure often require months.
• Injections generally require a series of visits.
• Cryotherapy and laser often require several sessions.
• Surgical combinations require prolonged postoperative prevention.
• Progress is assessed by height, pliability, colour, symptoms and movement.

Can a Treated Keloid Grow Again Years Later?

• Recurrence can happen months or years later.
• Early thickening, itching or firmness can signal renewed activity.
• Prompt review may limit substantial regrowth.
• A person who formed one keloid remains susceptible after future injuries.

When Should a Keloid Be Examined Promptly?

A keloid should be examined when it is growing, painful, function-limiting, emotionally distressing or behaving atypically.

When Is a Routine Dermatology Assessment Appropriate?

• The scar continues enlarging.
• It is painful or persistently itchy.
• It causes emotional distress.
• It restricts a joint.
• It blocks part of the ear canal.
• It catches repeatedly on clothing.
• A new scar begins thickening.
• Previous treatment failed.
• Another procedure is planned.

Which Changes Need Prompt Diagnostic Review?

• Rapid unexplained enlargement.
• Ulceration.
• Repeated spontaneous bleeding.
• A hard fixed mass beneath the scar.
• Growth without remembered injury.
• Pus, warmth or spreading redness.
• Sudden severe pain.
• Behaviour unlike previous keloids.
• Failure to respond as expected.

Honey-coloured crust, drainage and tenderness can suggest impetigo or another infection rather than stable scar tissue.

Spreading warmth, swelling and pain may suggest cellulitis, which requires medical assessment.

Can a Keloid Turn Into Cancer?

A true keloid is benign and does not ordinarily transform into cancer. The safety concern is that another growth can resemble a keloid or arise within altered skin, so atypical change may require biopsy.

What Should You Remember About Keloid Scars?

Keloids are benign raised scars that extend beyond the original wound because collagen-producing wound-healing signals remain active.

• The wound-boundary distinction separates keloids from hypertrophic scars.
• Piercings, acne, burns, surgery, tattoos and minor injuries can trigger them.
• Personal and family history strongly influence susceptibility.
• Common sites include ears, chest, shoulders, neck, jawline and upper back.
• Itching, pain, tightness and movement restriction can occur.
• Diagnosis is generally clinical.
• Atypical lesions may require biopsy.
• Avoiding elective skin trauma offers the strongest prevention.
• Silicone begins only after wound closure.
• Pressure and injections require consistent follow-up.
• Cryotherapy and laser are often combined with other methods.
• Surgery alone has a high recurrence risk.
• Selected recurrent lesions may receive postoperative radiation.
• Treatment can improve keloids but cannot guarantee permanent removal.

Frequently Asked Questions About Keloid Scars?

Which Sources Support This Keloid-Scar Guidance?