Keloid Scar

Overview

A keloid scar is a scar that grows too much. When your skin heals after an injury, it makes a protein called collagen to close the wound. In a keloid, the skin keeps making extra collagen even after the wound has closed. The result is a raised, firm lump that spreads beyond the edges of the original injury. A keloid is not cancer and it is not contagious. It cannot be spread to other people. It is simply your skin's healing process working a little too hard. Keloids can be pink, red, purple or darker brown than the skin around them, and they often feel itchy, tender or tight.

Keloids are fairly common. How often they happen depends a lot on skin type and family background. They are much more common in people with darker skin, and in some groups they affect a noticeable share of the population. Many people who get one keloid will get another if their skin is injured again in the same way.

Keloids can affect anyone, but they are most common in people of African, African-Caribbean, South Asian and Hispanic heritage, and in people with darker skin tones. They usually first appear between the ages of about 10 and 30. Both men and women get them. If someone in your family gets keloids, you may be more likely to get them too. They are more likely to form on the chest, shoulders, upper back, jawline, cheeks and earlobes, and on skin that is pulled tight.

Symptoms

Common symptoms

• A raised, firm lump of skin at the site of an old injury, surgery or piercing
• The lump extends wider than the original cut or wound
• Colour that is pink, red, purple or darker than the skin around it
• Itching, burning, tenderness or a pulling feeling
• The scar feels tight, especially if it sits over a joint
• Slow growth over weeks or months, sometimes continuing for a year or more
• The surface may look shiny and smooth, and it may feel rubbery or hard

Symptoms in children

• Keloids can start in childhood, often after ear piercing, burns, chickenpox spots or falls
• Children may complain that the scar itches or hurts, or they may scratch at it
• A young child may not be able to tell you it is uncomfortable, so watch for scratching or rubbing
• Ear piercing is a common trigger, particularly on the upper ear
• Children's scars can grow quickly at first, so it is worth showing any new raised scar to a doctor

Symptoms in older adults

• New keloids are less likely to start after the age of about 30, but they can still appear
• Keloids that formed years ago may slowly soften or flatten with time
• Older skin is thinner. Pressure garments and sticky silicone sheets may need extra care to avoid irritating it
• If a long-standing scar suddenly changes, grows, bleeds or becomes painful, get it checked. This is not usually a keloid problem, but it is worth ruling out other causes

Causes

Main causes

• The skin's healing response makes too much collagen, the protein that gives skin its structure, and keeps making it after the wound has closed
• Any injury that breaks the skin can trigger a keloid, including cuts, burns, surgery scars, acne, chickenpox spots, tattoos and ear or body piercings
• Sometimes a keloid appears after something as small as an insect bite, a scratch or a vaccination site
• Occasionally a keloid seems to appear with no obvious injury at all

Risk factors

• Having darker skin, particularly African, African-Caribbean, South Asian or Hispanic heritage
• A family history of keloids
• Being between about 10 and 30 years old
• Being pregnant or going through puberty, when hormone levels are changing
• Having a keloid before. This raises the chance of getting another one
• Injuries in areas where the skin is tight, such as the chest, shoulders, upper back, jawline and earlobes
• Wounds that heal slowly, get infected, or are closed under tension

When to see a doctor

See a doctor urgently if:

• A scar or wound that becomes hot, swollen and very painful, or starts oozing pus
• A keloid that bleeds or develops an open sore
• A scar over a joint that is stopping you from moving normally
• A lump that is growing quickly or looks very different from your other scars

Book a routine appointment if:

• You have a raised scar that is itchy, sore or spreading beyond the original wound
• A scar is bothering you because of how it looks or how it feels
• You are planning surgery, a piercing or a tattoo and have had keloids before
• A keloid is not improving after several months, or treatment you have tried is not helping

Diagnosis

A doctor can usually tell whether a scar is a keloid just by looking at it and asking how it started. They will check where it is, how far it spreads beyond the original injury, how it feels, and whether it is causing tightness. This is usually quick and painless. If the diagnosis is unclear, or the lump does not look like a typical scar, your doctor may suggest a small test.

Tests that may be done

• Usually no tests are needed. The diagnosis is made from the history and a simple examination
• Sometimes a small skin sample (a biopsy) is taken and checked in a laboratory to rule out other types of skin growth
• Occasionally a specialist skin doctor (dermatologist) is asked for an opinion

What to expect at your appointment

Your appointment will be short and simple. Your doctor will look at the scar, ask when it appeared and what caused it, and ask whether it itches or hurts. They may ask about other scars and about keloids in your family. You can ask about treatment options and about what to expect if you are planning surgery or a piercing. Bring a list of questions if that helps you remember them.

Treatment

There is no single treatment that works for everyone, and results vary from person to person. The aim is to make the scar flatter, softer and less itchy, and to improve how it looks. Because keloids can come back, treatment often combines more than one approach and may take several months. Ask your doctor which options suit your scar and your skin.

Self-care at home

• Use a silicone gel sheet or silicone gel on the scar as advised. Silicone is a common first step and can help soften and flatten a scar over time.
• Gently massage the scar if your doctor or scar service suggests it. Gentle pressure can help it feel less tight.
• Protect the scar from the sun. Sun exposure can make scars look darker. Use sunscreen and cover up.
• Avoid picking, scratching or rubbing the scar. This can make it more irritated and may make it grow.
• Wear loose, soft clothing over scars on the chest, shoulders or back to reduce friction.
• If a scar over a joint feels tight, ask about stretches or physiotherapy to keep movement easy.
• Keep the skin clean and moisturised, and treat acne and skin infections early so they do not leave new scars.

Medical treatments

Doctors have several ways to treat keloids. These include silicone sheets and gels, pressure therapy with special garments or clips (useful for earlobe keloids), and injections given into the scar by a healthcare professional to calm the extra scar tissue and reduce itching. Other options include freezing the scar tissue, laser treatment, and, for some people, specialist treatments such as light therapy or radiotherapy given by a specialist team. Treatment is often repeated over weeks or months. Your doctor will explain what is available, how long it may take, and what results are realistic for you.

When is surgery considered?

Surgery to cut out a keloid is only sometimes an option. This is because cutting a keloid can trigger it to grow back, and it may come back bigger. For that reason, surgery is usually combined with another treatment, such as injections or pressure therapy afterwards, to lower the chance of recurrence. Surgery may be considered when other treatments have not helped, when the keloid is very large, or when it is causing problems with movement. Your doctor or specialist will discuss the risks and benefits with you.

Living with this condition

Most people live a normal life with keloids. They may be itchy or tender from time to time, and they can feel tight if they cross a joint. Many keloids slowly settle down, becoming flatter and softer over the years. A simple routine of caring for your skin, protecting the scar from the sun and using any treatment your doctor suggests can make a real difference.

Lifestyle tips

• If you are thinking about a piercing, tattoo or elective surgery and you have had keloids, talk to your doctor first. You may choose to avoid it or plan it carefully.
• Treat acne, cuts and burns promptly, and keep wounds clean and covered while they heal.
• Try not to scratch. If itching is a problem, ask your doctor or pharmacist for advice.
• Give your skin time to heal between treatments and avoid harsh scrubs or strong skin products on the scar.
• Shops and clinics offer special creams, patches and covers to camouflage scars. Some people find these helpful for confidence.

Diet and exercise

There is no special diet that prevents or cures keloids. Eating a healthy, balanced diet helps your skin heal well in general. Exercise is good for you and usually safe. If a keloid sits over a joint, choose activities that feel comfortable and tell a physiotherapist or doctor if movement is painful or limited. Use sunscreen on scars when you are outdoors, as sun damage can darken them.

Mental health and emotional wellbeing

Keloids sit on visible parts of the body, such as the chest, face and ears. It is completely normal to feel self-conscious, frustrated or upset about how they look. Some people avoid swimming, sport or social events, or feel low about their appearance. These feelings are valid and worth talking about. If a scar is affecting your mood, sleep or confidence, please tell your doctor. Support is available and can help.

Prevention

You cannot change your skin type or your family history, so keloids cannot always be prevented. But you can lower your chances. Avoid unnecessary skin injuries if you are prone to keloids. If you need surgery or a piercing, tell your doctor or piercer about past keloids, because extra care can be taken. Treat acne and other skin problems early, and follow advice on wound care so wounds heal well. Silicone and pressure treatments started early on a new scar may help some people.

Vaccines

There is no vaccine for keloids. Keeping up to date with routine vaccinations is still good for your general health. Some people notice a small scar at a vaccination site, but this is uncommon.

Screening programmes

There is no screening programme for keloids. Instead, keep an eye on any new raised scar. If it keeps growing, becomes painful or changes, have it checked by a doctor. If you have had keloids before, let any person treating your skin know.

Complications

If left untreated

• The scar may keep growing for a while and end up larger than it needed to be
• Ongoing itching, tenderness or a pulling feeling
• A tight scar over a joint can limit how well that joint moves
• Keloids can be a source of embarrassment or distress, particularly on the face or ears
• A keloid removed by surgery alone can grow back, sometimes bigger than before
• Less commonly, a scar can become irritated or sore, especially where clothing rubs it

Long-term outlook

The outlook is generally good. Keloids are harmless, and many soften and flatten slowly over time. Treatment can ease itching, improve tightness and make a scar less noticeable, though results vary and it may take months. Some people have a few treatments over the years. With good advice, careful wound care and support when you need it, most people find a routine that works for them.

Find support

External links open third-party websites. Ruqelo Health is not responsible for external content. Listing an organisation does not imply endorsement.