Keloid Scars

Overview

A keloid scar is a raised, thick scar that keeps growing after the original injury has healed. Instead of staying within the edges of the wound, it spreads beyond them into the surrounding skin. Keloids feel firm and rubbery, look shiny or hairless, and can be pink, red, purple or darker brown than the skin around them. They are not dangerous and they are not cancer — they are simply an overenthusiastic healing response.

Keloids are fairly common. They are seen in all populations, but they are much more frequent in people with darker skin, where they affect a noticeable number of people. Many people who get one keloid are likely to get more, so doctors often see them as a pattern rather than a one-off.

Keloids can affect anyone at any age, but they most often start between the ages of about 10 and 30. They are more common in people of African, African-Caribbean, South Asian, East Asian and Hispanic background, and in people with a family history of keloids. They affect men and women roughly equally, and pregnancy can sometimes make them more likely or more active.

Symptoms

Common symptoms

• A raised, firm, rubbery lump of skin at the site of an old injury
• The lump extends beyond the original wound edges, sometimes with a claw-like shape
• The surface looks shiny and smooth, and hair does not grow on it
• Colour is often pink, red, purple or darker brown than surrounding skin
• Itching, tenderness, burning or sharp twinges, especially during growth spurts of the scar
• Tightness or a pulling feeling, particularly if the scar crosses a joint
• Slow growth over months or years, with the scar rarely fading much on its own

Symptoms in children

• Same appearance as in adults — raised, firm, growing beyond the wound
• Ear piercing is a very common trigger in older children and teenagers
• Scars can grow faster during growth spurts and puberty
• Children may scratch or pick at an itchy keloid, which can cause small wounds or infection
• Children may feel self-conscious at school, especially if the scar is on the face, chest or ear

Symptoms in older adults

• New keloids are less likely to start after the mid-30s, but they can still occur
• Older keloids may become less itchy or painful over time
• Skin heals more slowly with age, so wound care after surgery or injury matters more
• Existing keloids can still be treated at any age, though response may be slower

Causes

Main causes

• Overproduction of collagen — the protein that gives skin its structure — while a wound heals
• The healing process keeps going after the wound has closed, so extra tissue builds up
• Any break in the skin can trigger one: cuts, grazes, burns, surgery, acne, chickenpox, tattoos, piercings, vaccination sites or even insect bites
• Sometimes a keloid appears with no remembered injury at all

Risk factors

• Darker skin types, especially African, African-Caribbean, South Asian, East Asian and Hispanic backgrounds
• A family history of keloids — they often run in families
• Being between about 10 and 30 years old
• Having had a keloid before, or a previous raised scar
• Ear piercing, especially on the upper ear cartilage
• Wounds that are deep, infected, burn-related or under tension, such as on the chest, shoulders, upper back, jawline and earlobes
• Pregnancy, which can make scars more active
• Some rare inherited conditions that cause many keloids across the body

When to see a doctor

See a doctor urgently if:

• Any sign of infection in a wound or scar: pus, spreading redness, increasing pain, a bad smell or a temperature
• A scar that starts bleeding or develops an open sore that does not heal
• A rapidly growing, painful or very hot lump
• A keloid that is so tight it restricts movement or causes numbness

Book a routine appointment if:

• You have a raised scar that grows beyond the original wound and you want a diagnosis
• The scar itches, hurts or bothers you day to day
• You are unhappy with how the scar looks and want to discuss treatment
• You are planning a piercing, tattoo or elective surgery and have had keloids before
• You have acne or another skin condition that keeps leaving raised scars

Diagnosis

In most cases a doctor can recognise a keloid just by looking at it and feeling it. They will ask how it started, how long it has been there, whether it has grown beyond the original wound, and whether you have had keloids or raised scars before. No special test is usually needed.

Tests that may be done

• Physical examination — checking the shape, firmness, colour and size of the scar
• Medical history — previous injuries, surgery, piercings, acne, family history of keloids
• Photographs to track changes in size over time
• A skin biopsy or skin swab is only needed in unusual cases, for example if the diagnosis is unclear or the scar looks infected

What to expect at your appointment

Your appointment is usually a short conversation and a skin examination. If a biopsy is needed, a small sample of skin is taken under local anaesthetic and sent to a laboratory. A biopsy does not make a keloid worse in most cases, but your doctor will weigh up the pros and cons because any cut can sometimes trigger new scar tissue. Ask about waiting times and results in your local service.

Treatment

There is no single treatment that works for everyone, and no treatment guarantees the keloid will not come back. The usual aim is to make the scar flatter, softer and less itchy or painful, and to improve how it looks. Treatments are often combined, and results come slowly — think months rather than weeks. Your doctor will discuss options based on the size, position and symptoms of your scar, and your skin type.

Self-care at home

• Use a silicone gel or silicone sheet over the scar, as advised — it is one of the simplest and best-studied home options
• Massage the scar gently with your fingertips for a few minutes a day if your doctor or pharmacist suggests it
• Protect the scar from the sun with clothing or high-factor sunscreen to reduce darkening
• Keep the scar moisturised to reduce itching and dryness
• Avoid picking, scratching or shaving over the scar
• Avoid tight straps, belts or clothing that rub the scar
• Do not try to remove or cut the scar yourself, and avoid skin-lightening products that are unregulated

Medical treatments

Doctors may inject medicine directly into the scar to soften and flatten it, usually over several visits. Other options include freezing the scar, laser therapy to reduce redness and thickness, silicone treatment, and pressure garments. Some treatments are uncomfortable and need to be repeated, and your doctor will explain the risks, the number of sessions likely and how well each option tends to work for a scar like yours. If a wound or scar becomes infected, treatment for the infection is needed first.

When is surgery considered?

Surgery is sometimes an option, but cutting out a keloid on its own has a high chance of the scar coming back — often bigger. Because of this, surgeons usually combine removal with other treatments, such as injections, pressure or silicone, to lower the chance of recurrence. Surgery may be considered when the keloid is very large, keeps getting infected, or is so tight it limits movement. Your doctor will discuss whether the likely benefit is worth the risk for you.

Living with this condition

Keloids can be managed day to day even if they never fully disappear. Keep the scar clean, moisturised and protected from the sun, and be gentle with it. Covering it with clothing or a soft dressing can reduce rubbing and help you feel less self-conscious. Taking a photo every few months can help you see slow improvements that are hard to notice day by day.

Lifestyle tips

• Think carefully before getting piercings, tattoos or elective cosmetic procedures, especially if you have had keloids or have darker skin
• Treat acne early and avoid squeezing spots, which can leave raised scars
• Clean and cover any new cut, graze or burn promptly, and keep it moist while it heals
• If you need surgery, tell your surgeon you are prone to keloids so they can plan scar care
• Avoid smoking, which slows healing, and manage health conditions like diabetes that affect wound healing

Diet and exercise

No specific diet has been proven to prevent or shrink keloids, so there is no special eating plan to follow. A balanced diet, plenty of water and not smoking all support good skin healing. Exercise is safe and encouraged — just avoid repeated friction on the scar from straps, equipment or tight clothing, and protect healing wounds from dirt and sweat until they have closed.

Mental health and emotional wellbeing

Keloids are visible, and it is very normal to feel self-conscious, frustrated or low about them, especially if they are on the face, neck, chest or ear. Some people avoid swimming, sport or social situations because of their scar. These feelings are valid and worth mentioning to your doctor. Visible differences can affect mood and confidence, and support is available if they are weighing on you.

Prevention

Not entirely — some people are simply more likely to form keloids, and that tendency cannot be removed. But you can lower your chances of new ones. Avoid unnecessary skin injury if you know you are prone: think twice about piercings, tattoos and cosmetic surgery. Treat acne promptly, avoid squeezing spots, and clean and cover any cut, graze or burn. After surgery or a significant injury, ask your doctor whether silicone gel, silicone sheets or pressure treatment would be sensible for you. Catching a keloid early may make it easier to treat.

Vaccines

Recommended vaccines are still important — avoid skipping them because of scar concerns. Keloids can form at an injection site in people who are prone to them, but this is uncommon. If you have had a keloid at an injection site before, tell the person giving the vaccine so they can choose a site carefully. Any new vaccine decisions should be discussed with your doctor.

Screening programmes

There is no screening test for keloids. Instead, the focus is on checking your own skin. If you have a raised scar that keeps growing beyond the wound edge, or a scar that changes, itches, hurts or bleeds, get it checked by a doctor rather than waiting.

Complications

If left untreated

• The scar may keep growing for months or years and become larger and more raised
• Itching, tenderness or pain may continue or worsen
• Tightness across a joint can restrict movement, and tight scars on the face can pull on nearby features
• Repeated irritation or scratching can cause small wounds or infection
• Removal by surgery alone carries a high risk of the keloid coming back larger
• Ongoing distress about appearance can affect confidence, mood and social life

Long-term outlook

The outlook is generally good. Keloids are harmless, and many slowly flatten and soften over several years, even without treatment. Treatment cannot always remove a keloid completely, but it can make a real difference to how it looks, feels and bothers you. Combining treatments usually works better than any single option, and starting early often helps. With a plan from your doctor and a little patience, most people find a way to manage their scars comfortably and get on with life.

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