Keloids
A keloid is a scar that keeps growing after the wound has already healed, spreading past the edge of the original injury. Keloids are not cancer, but they can itch, hurt and keep enlarging, and they are far more common on deeper skin tones.
Key facts
Keloids at a glance.
Typical signs
Scar growing beyond the wound
Common locations
Earlobes, chest, shoulders, jaw
Expected course
Persistent; recurrence common
Treatment options
Silicone, injections or combined procedures
What is it?
Top things to know about Keloids
- It is an overgrown scar. A keloid extends beyond the boundaries of the original skin injury.
- It can persist. Keloids can stay raised, itchy or painful long after the wound heals.
- It is benign but stubborn. Treatment can be difficult and recurrence is common.
- Not every raised scar is a keloid. Unusual or changing growths may need a biopsy.
What it looks like
What Keloids looks like
Keloids are raised scars that grow beyond the edges of the original wound. They are firm, smooth and shiny, and they can keep growing for months or years. Common sites include the earlobes, chest, shoulders and upper back. They may itch, feel tender or hurt. Keloids can form after piercings, acne, surgery, burns, vaccinations or even minor scratches.
Raised scars come in two types that are easy to confuse. The difference affects treatment and the chance of coming back.
Keloid scar
Grows past the wound edge; often returns.
Earlobe keloid
A rounded scar grows around an ear-piercing site.
Hypertrophic scar
Stays within the wound; may flatten.
Where it shows up
Location varies
A keloid develops at a site of skin injury; it does not have one fixed distribution.
On different skin tones
Keloids on different skin tones
Keloids can form on any skin tone, but they are far more common in brown and Black skin. On lighter skin, they often look pink or red. On darker skin, they are often darker brown or purple than the surrounding skin. People prone to keloids may want to avoid elective piercings and cosmetic surgery.
What happens in Keloids?
Scar-producing cells keep making collagen after a wound has closed. The resulting dense scar grows beyond the boundaries of the original injury.
- The scar extends outward: Growth passes the original wound edges.
- Healing signals remain active: Scar-producing cells keep making collagen.
- Collagen builds up: Dense scar tissue enlarges the area.
Causes and triggers
What causes Keloids
Causes
Why it happens
Keloids form when the body makes too much collagen while healing a wound. The scar keeps growing past the original injury.
Keloids often run in families and are far more common in people with darker skin.
Risk factors
Raise the odds
- Darker skin
- Ages 10 to 30
- Family history
- Pregnancy
Triggers
Bring it on or make it worse
- Ear piercing (Well established)
- Surgery (Well established)
- Acne (Strong link)
- Burns (Strong link)
- Vaccinations and tattoos (Possible)
When it usually starts
When it usually starts
Keloids
Often arise in teenagers and younger adults after a skin injury, piercing or inflamed spot.
Daily care
Daily care for Keloids
Telling every clinician
Tell clinicians about your keloid history before procedures or piercings.
Daily sunscreen over the scar
Stops the marks around it from deepening.
Silicone sheets or gel
The best-supported option without a prescription.
Pressure earrings after treatment
Worn for months, they cut recurrence.
Treating the acne or folliculitis
Controlling inflammation stops new keloids.
Discuss a combined treatment plan before keloid removal
Surgery plus injections or radiation limits recurrence.
Adding another injected medicine
Triamcinolone is often combined with 5-fluorouracil.
Silicone or paper tape on a new scar
Taping cuts tension for the first months.
Discuss recurrence prevention before keloid surgery
It comes back most times, often bigger.
Avoid: Any new injury to high-risk skin
Piercings, tattoos and mole removals each start one.
Avoid: Re-piercing a keloided earlobe
The surest way to make it bigger.
Avoid: Shaving that causes ingrown hairs
Repeated bumps build into keloidal scarring.
Avoid: Picking, squeezing or scratching
Restarts the inflammation.
Avoid: Tension across the scar
Mechanical stress drives more growth.
Avoid: Rubbing from clothing or straps
Backpack, bra and helmet straps irritate it.
Avoid: Untreated inflamed acne
Every deep spot is a wound in the riskiest skin.
Avoid: Waiting to see if it settles
Old, hard keloids improve less.
Avoid: Stopping treatment once it flattens
Keloids re-thicken if you abandon the course.
Avoid: Delayed healing or wound infection
The longer it stays inflamed, the more the scar overshoots.
Treatments
Treatments for Keloids
Silicone sheets and gel
The best-supported thing you can buy for keloids without a prescription. Worn or applied over the scar for most of the day, over months, it softens and flattens it and eases the itch. It works best on new scars and on preventing one after a wound, and it will not clear a hard, old keloid on its own.
Pressure earrings
Clip-on discs that squeeze an earlobe keloid from both sides, used mainly after a keloid has been injected or removed. They have to be worn for many hours a day for months to cut the chance of it coming back. They are uncomfortable at first, and stopping early is the usual reason they fail.
Silicone or paper tape on new scars
Taping a fresh scar takes some of the pull off it while it is healing, which matters most on the chest and shoulders where tension keeps a keloid growing. It is used for the first few months after a wound closes. It is prevention rather than treatment, and it does nothing for a keloid that is already established.
Onion extract gel
Widely sold as a scar gel, and the studies behind it are small and mostly unconvincing for keloids. Some people find it makes the scar feel more comfortable, which is not nothing. If you are choosing one product to buy, silicone is the better use of the money.
Vitamin E
Rubbing vitamin E oil on a keloid is one of the most common pieces of advice given, and it has not been shown to flatten one. In some people it also causes an itchy rash where it is applied. It is not a reason to delay treatment that works.
Clobetasol
Clobetasol Propionate. A strong steroid ointment put on the keloid and covered overnight, usually to take the edge off itching between injection appointments. Covering it is what gets any of it through thick scar tissue. It will not flatten a keloid on its own, and long spells of use thin the normal skin around the scar.
Steroid-impregnated tape
A thin tape with steroid built into it, cut to the size of the scar and worn most of the day. It gives steady low-dose treatment plus a little pressure, and it suits small keloids and people who want to stretch the gap between injections. It is fiddly on hairy skin and can irritate the skin at the edges.
Cortisone Injection
Triamcinolone Acetonide. The standard first treatment for a keloid: steroid injected directly into the scar, usually every four to six weeks. It calms the long-running inflammation and slows the cells making collagen, so itch and pain settle first and flattening follows over months. The main trade-off is a pale, thinned patch where it was given, which shows more on deeper skin tones.
5-fluorouracil injection
A second medicine mixed with the steroid, or given on its own, when a keloid is stubborn or keeps returning. It targets the collagen-making cells directly, and combining it with triamcinolone works better than steroid alone in most studies. It stings more, and it can leave the surface sore or ulcerated for a short time.
Bleomycin Injection
Bleomycin injection. A chemotherapy drug used in tiny amounts inside the scar for keloids that have not responded to steroid and 5-fluorouracil. Small studies show it can flatten them. It is not widely offered, and dark spotting of the skin over the injection site is common, so it is a later option rather than an early one.
Radiation
A short course of low-dose radiation given within a day or two of removing a keloid, to stop the scar tissue rebuilding. For keloids that have already come back after surgery, it lowers the chance of another recurrence considerably. It is only available at some centers, and the long-term risks are discussed carefully before it is used, particularly in younger people.
Cryotherapy
Freezing can soften and flatten smaller keloids, and is sometimes used just before an injection to make the scar easier to inject. The problem is that freezing destroys pigment cells and often leaves a permanent white patch. On deeper skin tones, where most keloids occur, many dermatologists use it cautiously or not at all.
Excision
Cutting the keloid out works only as part of a plan. On its own it comes back in the large majority of cases, often bigger, so it is paired with injections at the time of surgery, pressure afterwards, or radiation. It is most useful for a big earlobe keloid or one that is limiting movement, where nothing else will get it flat.
V-Beam
A laser aimed at the blood vessels in the scar. It helps with the redness, and some people find it softer and less itchy afterwards, so it is used alongside injections rather than instead of them. It does not flatten a thick keloid, and settings have to be chosen carefully on deeper skin tones to avoid pigment change.
Outlook
What to expect with Keloids
Keloids follow a slow pattern, and the first months are when treatment helps most. Nothing looks unusual early, so the change often arrives months after the wound closed.
- 1
Weeks 0 to 4 · Healing
Nothing looks unusual yet, which is why keloids surprise people.
- 2
Months 1 to 3 · Rising
It turns thicker, firmer, redder or darker, and usually itchy. This is where a keloid and an ordinary healing scar diverge.
- 3
Months 3 to 12 · Growing past the edge
It grows out into surrounding skin. Itching, tenderness and a pulling feeling are common, and this is the phase people come in with.
- 4
Year 1 to 2 · Firming
It gets harder and paler but does not flatten the way a hypertrophic scar does. Most keloids stay, and some enlarge slowly for years. Do not plan around it clearing on its own.
- 5
With treatment · Flattening
Steroid injections are repeated every four to six weeks, and you judge progress over months. A treated keloid leaves a flat mark, not normal skin. Keloids come back readily, especially after surgery alone, so follow-up and repeat treatment are normal, not a sign something went wrong.
Complications
Complications to know about
Coming back larger after surgery
A keloid cut out on its own comes back in most people, and often larger than the one that was removed, because the operation is another wound in the same high-risk skin. Surgery is still used, but as part of a plan with injections, pressure or radiation afterwards. If someone offers to simply cut it off, ask what will be done to stop it returning.
Itch, pain and tightness
Keloids frequently itch, sting or ache, and one sitting over a joint, the chest or an ear can feel tight and limit movement. For most people this, not the look of it, is the reason to get it treated. Itch and pain usually settle before the scar flattens, so treatment often feels worthwhile well before it looks it.
Pale, thinned skin after injections
Steroid injections can leave a pale, slightly sunken patch where they were given, and on deeper skin tones that lightening shows more and can last a long time. It often improves over months. Raise it before the first injection so the dose and technique are chosen with it in mind.
When to get help
When to get help
When to seek care
Seek assessment for a growing, painful or itchy scar, or any lump whose diagnosis is uncertain. Discuss scarring risk before elective skin procedures.
Lookalikes
What else could it be?
Epidermal Inclusion Cyst
A cyst often feels like a ball under the skin and may have a tiny opening. A keloid is fixed scar tissue without that opening.
Acne Scarring
Most acne scars stay within the original spot. A keloid keeps growing beyond that spot into previously clear skin and may feel firm and itchy.
Questions
Questions you might be asking.
Will my keloid ever go away completely?
Realistically, no. The goal is flat, soft and no longer itchy or painful, which leaves a flat mark rather than normal skin. Most improve a great deal; very few disappear.
Can I get my ears pierced again if I have had a keloid?
It is a real risk worth discussing rather than deciding alone. Re-piercing through or next to a keloid often makes it bigger. If you go ahead, some dermatologists treat around the piercing preventively and add pressure earrings. Going back to the same studio with no plan is the version that goes badly.
Why did I get one on my chest but not on my leg?
Site matters as much as skin. The chest, shoulders, earlobes, jawline and back of the neck are high risk, partly because that skin is under constant tension and movement. The same injury heals flat on the leg and keloids on the sternum.
Do steroid injections hurt, and how many will I need?
They sting, and a firm keloid makes it uncomfortable, but it takes seconds. Most people need several, usually every four to six weeks, and the number depends on size, site and how long it has been there. Itching and pain improve first, flattening later.
Will the injection lighten my skin?
It can. A pale, slightly sunken patch at the injection site is a recognized side effect, more noticeable on deeper skin tones, and it often improves over months. Raise it before the first injection.
I have a keloid and I need surgery for something unrelated. What should I do?
Tell the surgeon before the operation, not afterward. It changes where the incision goes, how it is closed, whether the wound is taped, and whether preventive injections are given. Ask what will be done differently because of your keloid history.
Sources
Sources and further reading
Related
Keep exploring.
Cortisone Injection
Cryotherapy
V-Beam
Surgical Excision
Acne Scarring
Epidermal Inclusion Cyst
Clobetasol
Vitamin E
Acne Scarring vs Keloids
Keloids vs Epidermal Inclusion Cyst
Dermatofibroma vs Keloids
