Keloid Scars

Keloid scars are raised, firm areas of excess scar tissue that grow beyond the edges of an original skin injury. They are benign, non-cancerous scars, but they may cause itching, tenderness, cosmetic concern or restriction of movement depending on their size and location.

Overview

Keloid scars are an abnormal type of scar in which healing tissue grows thicker and wider than expected. Unlike a typical scar, a keloid extends beyond the boundaries of the original wound and may continue to grow slowly over time. Keloids are benign and do not become cancer, but they can affect comfort, appearance and confidence.

A keloid may appear after almost any type of skin injury. Common triggers include surgical incisions, burns, ear or body piercings, acne spots, cuts, scratches, insect bites, vaccinations and areas of repeated friction. In some people, even a very small injury can lead to a noticeable raised scar.

Keloid scars most often develop on areas such as the chest, shoulders, upper back, earlobes, jawline and neck, although they can occur anywhere on the body. They tend to be more common in people with darker skin tones and in individuals with a personal or family history of keloids. Early assessment can help guide treatment and reduce the chance of further irritation or enlargement.

Symptoms

The main sign of a keloid scar is a raised area of scar tissue that grows beyond the original injury. It may feel firm, rubbery or smooth. The color can vary from pink, red or purple to darker brown, depending on skin tone and how long the scar has been present.

Keloids can develop gradually over weeks or months. Some remain stable after a period of growth, while others continue to enlarge slowly. They may be round, oval, lumpy or irregular in shape. On the earlobe, a keloid may appear as a firm nodule; on the chest or shoulder, it may form a broad, raised plaque.

Symptoms can include:

• Itching, tingling or burning in the scar
• Tenderness or pain when touched or rubbed by clothing
• A tight or pulling sensation in the surrounding skin
• Cosmetic concern, especially when the scar is visible
• Reduced movement if a large scar crosses a joint or tight skin area

Keloids are not contagious and do not spread from person to person. However, new keloids can form in different areas if the skin is injured again, particularly in someone who is prone to this type of scarring.

Causes & Risk Factors

Keloid scars are caused by an overactive wound-healing response. During normal healing, the body produces collagen to repair injured skin. In keloid formation, collagen production continues in an unbalanced way, creating excess scar tissue that rises above the skin and extends beyond the original wound.

The exact reason why some people develop keloids is not fully understood. Genetics, skin biology, inflammation and the depth or location of injury all appear to play a role. Keloids can occur after major wounds, but they may also follow mild acne, razor bumps, ear piercing, tattoos, burns or minor skin trauma.

Risk factors include:

• A personal history of keloid scars
• A family history of keloids
• Darker skin pigmentation
• Younger age, especially adolescence and early adulthood
• Skin injuries on the chest, shoulders, upper back, neck, jawline or earlobes
• Repeated irritation, tension or inflammation around a healing wound

Not every raised scar is a keloid. Hypertrophic scars can also be thick and raised, but they usually stay within the original wound edges and may flatten over time. A specialist can distinguish between these scar types and recommend an appropriate approach.

Diagnosis

Keloid scars are usually diagnosed by clinical examination. A dermatologist, plastic surgeon or qualified doctor will look at the scar, ask when it started, how it has changed and whether there was a known trigger such as surgery, acne, piercing or injury. The doctor may also ask about previous scars and family history.

During examination, the specialist assesses the size, shape, color, thickness, symptoms and location of the scar. They also check whether the scar extends beyond the original wound, which is a key feature of keloids. Photographs or measurements may be used to monitor changes over time and evaluate the response to treatment.

Additional tests are not usually required. In uncommon situations, if the appearance is unusual, if the scar changes rapidly, bleeds, ulcerates or does not fit the typical pattern, a small skin biopsy may be recommended to rule out other skin conditions. This decision is made by the treating doctor based on individual findings.

Treatment Options

Treatment for keloid scars aims to flatten and soften the scar, reduce itching or pain, improve appearance and lower the chance of further growth. The best approach depends on the scar size, location, symptoms, previous treatments, skin type and the person’s tendency to form keloids. A specialist should assess the scar before deciding on treatment.

Non-surgical options may include silicone gel or silicone sheets, pressure therapy, dressings, scar massage guidance and measures to reduce irritation. Medical treatments may include injections into the scar to reduce inflammation and excess collagen activity. Laser and light-based treatments may help improve redness, thickness or texture in selected cases. Cryotherapy may be considered for some smaller keloids.

Surgery may be used for certain keloids, particularly large, bulky or function-limiting scars. However, removing a keloid by surgery alone can lead to recurrence, because surgery creates a new wound in skin that is prone to keloid formation. For this reason, surgical removal is often combined with other specialist-directed treatments such as injections, pressure therapy, silicone therapy or carefully selected radiotherapy in appropriate cases.

Treatment often requires patience and follow-up, because keloids may improve gradually and can sometimes return. No single method is suitable for everyone. The right plan should be chosen by a dermatologist, plastic and reconstructive surgeon or another experienced clinician after a full assessment and discussion of expected benefits, limitations and possible side effects.

Living With / Prognosis

Keloid scars are long-term skin changes, but many people achieve meaningful improvement in comfort, thickness and appearance with appropriate care. Some keloids remain stable for years, while others may slowly enlarge or become symptomatic. Regular follow-up is useful when a scar is growing, painful, itchy or affecting movement.

Daily skin care can help reduce irritation. People prone to keloids are often advised to avoid unnecessary skin trauma, including non-essential piercings, tattoos or cosmetic procedures in high-risk areas. When surgery or medical procedures are necessary, patients should tell their doctor about any history of keloids so preventive scar management can be considered early.

Sun protection may help reduce color contrast between a scar and surrounding skin, especially while a scar is still maturing. Clothing friction, scratching and repeated pressure may worsen discomfort in some people, so practical measures such as soft fabrics or protective dressings may help when recommended by a clinician.

Keloids can affect emotional well-being, particularly when they are visible or associated with past injury or surgery. Supportive medical care includes listening to the patient’s concerns as well as treating symptoms. Acibadem International provides diagnosis and treatment for keloid scars through multidisciplinary specialists in JCI-accredited hospitals for international patients, with care planned according to individual assessment.

When to See a Doctor

A doctor should assess any raised scar that continues to grow, becomes painful, itches persistently or causes cosmetic concern. Early evaluation is especially helpful for people who have had keloids before, because prompt scar management may reduce worsening after new injuries or procedures.

Medical advice is also important if a scar limits movement, is repeatedly irritated by clothing or jewelry, or develops after surgery, burns, acne or piercing. People planning elective procedures such as ear piercing, tattooing or cosmetic surgery should discuss their keloid risk with a clinician beforehand.

Urgent assessment is recommended if a scar-like area bleeds without injury, ulcerates, becomes infected, changes very rapidly or has an unusual appearance. These changes are not typical of a stable keloid and may need further evaluation to exclude other conditions.

Frequently asked questions

What are keloid scars?

Keloid scars are raised overgrowths of scar tissue that extend beyond the original skin injury. They form when the body produces too much collagen during healing. They are benign and not contagious, but they may cause itching, tenderness or cosmetic concern.

What causes keloid scars to form?

Keloids form because of an overactive wound-healing response. They can develop after surgery, burns, acne, piercings, cuts, insect bites or even minor skin irritation. Genetics, darker skin tones and a previous history of keloids increase the risk.

Can keloid scars go away on their own?

Keloids usually do not disappear completely without treatment. Some may stop growing and become less symptomatic over time, but the raised scar often remains. Treatment can help flatten, soften or reduce symptoms, although recurrence is possible.

What is the best treatment for keloid scars?

There is no single best treatment for every keloid scar. Options may include silicone therapy, injections, laser treatment, pressure therapy, cryotherapy, surgery or combinations of methods. A specialist decides the most suitable approach after examining the scar and discussing the person’s goals and risk of recurrence.

Is keloid removal permanent?

Keloid removal is not always permanent because keloids can return, especially after surgery alone. To reduce recurrence risk, specialists often combine removal with other treatments such as injections, silicone therapy or pressure therapy. Long-term follow-up may be recommended.

Are keloid scars dangerous?

Keloid scars are not dangerous in the sense that they are non-cancerous and do not spread like an infection. However, they can be uncomfortable, itchy, painful or emotionally distressing. A doctor should review any scar that changes rapidly, bleeds, ulcerates or looks unusual.

How can someone reduce the risk of new keloids?

People prone to keloids can reduce risk by avoiding unnecessary skin trauma such as non-essential piercings or tattoos, especially in high-risk areas. If surgery or a medical procedure is needed, they should tell their doctor about their keloid history. Early wound care and specialist-guided scar prevention may help.

References

• American Academy of Dermatology Association
• British Association of Dermatologists
• DermNet New Zealand
• Cleveland Clinic
• National Health Service

This article is for general information only and is not a substitute for professional medical advice. Please consult a qualified doctor about your individual situation.