Keloid scars

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Keloid scars

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Rated

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Summary

Keloids are raised, firm scars that grow beyond the wound and don’t fade naturally.
It’s caused by injury, surgery, or acne, keloids result from excess collagen production.
Treatments include steroids, silicone gels, cryotherapy, and sometimes surgery.

Keloid scars: essential info
Causes and symptoms
What are my options?
FAQ

Reviewed on October 09, 2023. by

Dr Alexandra Cristina Cowell

Writer & Clinical Content Reviewer

Next review due on October 09, 2026

Last updated on October 08, 2023

Find the Keloid scars treatment that’s best for you.

We’ve got a range of options, and our clinicians can help you find the one that’s best for your body and your budget.

Dermatix Gel

Silicone

Reduces discolouration, itching, and pain whilst also flattening your scars.

Not available

Dermovate

Clobetasol propionate

A strong topical steroid that lessens itching and improves the appearance of your scars.

Not available

Elocon

Mometasone Furoate

Effectively reduces inflammation and itching. Branded version of Mometasone.

Not available

Mometasone

Mometasone furoate

Potent topical steroids that can improve inflammation and itching. Generic version of Elocon.

Not available

What are keloid scars?

Keloids are scars that form after abnormal wound healing, and they usually form because of an increased production of collagen and an overexpression of inflammatory molecules. Unlike normal scars that heal over time and fade, keloid scars don’t.^[1] They are raised, firm and are a different colour to the skin, making them more noticeable.

Keloid scars can take months to develop and continue to grow for several years. The most commonly affected areas are the chest, shoulders, earlobes and upper back.^[2] Although they aren’t usually painful, they can be itchy, tender and irritating.

There are several types of treatment for keloid scars, including topical treatments, silicone-based products and cryotherapy.^[3] The treatment you get will depend on how big your scar is and how deep it is in your skin. Standard topical treatments work to reduce inflammation and stop the production of collagen, which flattens the keloid.

Who can get keloid scars?

Anyone with a wound can get keloid scars, but it can depend on your ethnicity and location. It’s more common in black, Asian and darker-skinned individuals than those who have white or fairer skin. For example, the average keloid incidence in African countries is 5-10% compared to less than 1% in other countries.^[4]

Certain genetic mutations will also increase the risk of developing keloids. People with Rubinstein-Taybi syndrome (RTS), for example, have a higher chance of developing it. Some research also suggests that inherited genes increase the likelihood of developing keloids. Approximately 33%-50% of people with keloids have one blood relative with keloids.^[5]

How do keloid scars differ from hypertrophic scars?

Hypertrophic scars can easily be confused with keloid scars. Both are formed during healing and look similar (both are raised and firm). The main difference is hypertrophic scars usually remain at the site of injury and fade with time, whereas keloids expand outside the site of injury and don’t regress.^[6] This means treatment is needed to fade keloids.

Treated trusted sources:

McGinty, S. and Siddiqui, W.J. (2020). Keloid. [online] PubMed.
Tripathi, S., Soni, K., Agrawal, P. et al. Hypertrophic scars and keloids: a review and current treatment modalities. biomed dermatol 4, 11 (2020).
Ojeh, N., Bharatha, A., Gaur, U. and Forde, A.L. (2020). Keloids: Current and emerging therapies. Scars, Burns & Healing, 6, p.205951312094049.
Huang, C., Wu, Z., Du, Y. and Ogawa, R. (2020). The Epidemiology of Keloids. Textbook on Scar Management, [online] pp.29–35.
www.aad.org. (n.d.). Keloids: Overview.
Carswell, L. and Borger, J. (2020). Hypertrophic Scarring Keloids. [online] PubMed.

This page was written by The Treated Content Team.

This page was medically reviewed by Dr Alexandra Cristina Cowell on October 09, 2023. Next review due on October 09, 2026.

How we source info.

When we present you with stats, data, opinion or a consensus, we’ll tell you where this came from. And we’ll only present data as clinically reliable if it’s come from a reputable source, such as a state or government-funded health body, a peer-reviewed medical journal, or a recognised analytics or data body. Read more in our editorial policy.

What causes keloid scars?

Keloid scars form after a wound. This could be an artificial wound, caused by surgery, C-sections, piercings or tattooing, or a natural wound, caused by something like acne or injury.

There are three main steps in wound healing:

Inflammatory
Fibroblastic
Maturation^[1]

Keloids develop because of increased activity in the fibroblastic phase, where certain molecules (like one called TGF) responsible for collagen production are overexpressed.^[2] This increases the production of collagen up to 20x more than the normal amount.

Other molecules can also contribute to the formation of keloids, such as MMPs and TIMPs, which also contribute to your collagen levels. The function of MMPs is reduced and the function of TIMPs is increased. This causes collagen to not break down as it should, contributing to increased levels.^[3] As a result of these changes, scars are raised, thickened and firm.

How long do keloid scars last?

Keloids can form several months after a wound and last indefinitely without treatment. This is because of uncontrolled collagen production in the fibroblastic phase, causing the keloid to grow unless proper treatment is used.

Can keloid scars lead to other problems?

In most cases, keloid scars don’t lead to other health problems. However, people with keloids have a higher risk of developing cancer (especially skin and pancreatic). In a study involving 17,401 patients with keloids and 69,604 in the control group,^[4] 5.13% of patients with keloid developed cancer, compared to 3.5% in the control group. This suggests the cancer risk is 49% higher in people with keloid scars. The increased risk could be due to the similar environments needed for keloid formation and tumour growth (uncontrolled production and reduced degradation of molecules).^[5]

Treated trusted sources:

McGinty, S. and Siddiqui, W.J. (2020). Keloid. [online] PubMed.
Tripathi, S., Soni, K., Agrawal, P. et al. Hypertrophic scars and keloids: a review and current treatment modalities. biomed dermatol 4, 11 (2020).
Betarbet, U., & Blalock, T. W. (2020). Keloids: A Review of Etiology, Prevention, and Treatment. The Journal of Clinical and Aesthetic Dermatology, 13(2), 33-43.
Lu, Y., Tu, P., Wu, H., Hong, H., Yang, C., Yang, J., Chang, L., & Lee, H. (2021). Risk of cancer development in patients with keloids. Scientific Reports, 11.
Tan, S., Khumalo, N., & Bayat, A. (2019). Understanding Keloid Pathobiology From a Quasi-Neoplastic Perspective: Less of a Scar and More of a Chronic Inflammatory Disease With Cancer-Like Tendencies. Frontiers in Immunology, 10, 423043.

This page was written by The Treated Content Team.

This page was medically reviewed by Dr Alexandra Cristina Cowell on October 09, 2023. Next review due on October 09, 2026.

How we source info.

How are keloid scars treated?

Treatments for keloids vary from topical products to surgery. The treatment you receive is tailored to you and will depend on the location and size of the keloid.

Topical treatments such as steroids are commonly used to treat keloids. Dermovate, a steroid, contains the active ingredient clobetasol propionate which can flatten keloids. It has anti-inflammatory properties and can alter the immune system responses to prevent healing, causing the keloid to flatten.^[1]

Silicone gels are also effective at reducing scars. The statistics show silicon gel is 86% effective at reducing texture and 68% at reducing the height of the keloids.^[4] By increasing your skin’s hydration, it regulates collagen production and reduces fibroblastic activity. This flattens and softens the keloid. It also creates a barrier, preventing any bacteria from entering, and also reduces itching and discomfort.^[2]

Cryotherapy (surgery involving freezing temperatures) is a removal method for keloids. It flattens the scar by damaging the skin tissue and making it die. But external cryotherapy can cause side effects such as hypopigmentation. This can be avoided by inserting the needle in the keloid, preventing the melanocytes (cells that cause pigment) to die.^[3] Keloids can also be removed surgically, but there’s a 45%-100% chance of recurrence due to the incision. So it’s better to use another treatment after surgery, like steroids or radiotherapy, to avoid reoccurrence.^[3]

What medications are there for keloid scars?

As there is no one-size fits all approach when it comes to keloid treatment, there are a few things you have to consider before choosing a medication. Such as the size and location of your scars, as well as your medical history.

To reduce swelling in keloids, you can use Dermatix, a silicone gel ointment that regulates collagen production and reduces its levels. Alternatively, steroid-based treatments like Dermovate and Elocon dampen your immune system and reduce inflammation. Each of these treatments contains different active ingredients. This means if one doesn’t work, another might be more effective for you.

Do keloid scars always need treatment?

Keloids don’t always require treatment, but without it, the scars won’t fade. This can be irritating, painful and emotionally distressing, especially if it’s in a prominent area. Leaving keloids untreated will make them grow bigger and more noticeable. It’s better to treat them early on to prevent this.

Treated trusted sources:

McGinty, S. and Siddiqui, W.J. (2020). Keloid. [online] PubMed.
Tripathi, S., Soni, K., Agrawal, P. et al. Hypertrophic scars and keloids: a review and current treatment modalities. biomed dermatol 4, 11 (2020).
Ojeh, N., Bharatha, A., Gaur, U. and Forde, A.L. (2020). Keloids: Current and emerging therapies. Scars, Burns & Healing, 6, p.205951312094049.
Puri, N., & Talwar, A. (2009). The Efficacy of Silicone Gel for the Treatment of Hypertrophic Scars and Keloids. Journal of Cutaneous and Aesthetic Surgery, 2(2), 104-106.

How we source info.

FAQ: Keloid scars

Have something specific you want to know? Search our info below, or ask our experts a question if you can’t find what you’re looking for.

Can you prevent keloid scars?

Answer:

Keloids can be prevented with appropriate wound care, such as using an occlusive dressing like silicone gel sheeting (SGS) or compression therapy after surgery or injury. SGS creates a hydrated environment which prevents collagen production and reduces the formation of keloids. ^[2] Compression therapy involves applying pressure to the wound as it heals to prevent scarring.^[1]

If you are at a higher risk of developing keloids then getting a tattoo or piercing can trigger their formation, so be mindful of this when making your decision.

Can you get side effects with keloid scar treatment?

Answer:

As with all medications, there’s a risk of side effects (which will vary depending on what treatment you choose). Topicals like steroids are used for a short period to avoid withdrawal symptoms. The withdrawal symptoms usually cause redness, intense itching, peeling and more. But this can be avoided by closely following the directions for application. Generally speaking, the benefits of using keloid treatment outweigh any side effect risks.

For more information on side effects, check the patient leaflet that comes with your treatment.

Do keloid scars go away naturally?

Answer:

Keloids don’t go away naturally, and with time they often become bigger. To remove or fade them, treatment is always needed. If you have a keloid it’s best to start treatment early, so simpler methods, like compression dressings, are often used. Compression dressings involve wrapping a garment on your wound to apply pressure to it. This increases blood circulation, reduces swelling, and works best right after an injury. ^[3]

How are keloids diagnosed?

Answer:

Your doctor will diagnose keloids by looking at them; no special tests are required. However if your dermatologist isn’t sure then a skin biopsy might be performed. This involves taking a small sample of your skin and looking at it under a microscope. ^[4] It’s not a painful procedure, but an anaesthetic can be used in any case.

Can acne cause keloid scars?

Answer:

Keloid scars can form after acne. You can treat them using similar options, but the application of topical medications will be different if it’s on your face. ^[5]

Acne keloidalis nuchae is another disease that is characterised by inflammation of hair follicles near the neck that forms scars like keloids. It's typically caused by repeated friction to the area or by close shaving.^[6] It’s more common in men and people of African descent because of genetic factors. The treatment options are similar to normal keloid treatment, but it's better to avoid things which will lead to it where possible.

Treated trusted sources:

McGinty, S. and Siddiqui, W.J. (2020). Keloid. [online] PubMed.
Betarbet, U., & Blalock, T. W. (2020). Keloids: A Review of Etiology, Prevention, and Treatment. The Journal of Clinical and Aesthetic Dermatology, 13(2), 33-43.
Lu, J., Xu, T., Liu, Y., Yang, M., & Jiang, X. (2017). Pressure garment therapy for preventing hypertrophic and keloid scarring after a major burn injury. The Cochrane Database of Systematic Reviews, 2017(4).
British skin foundation. (2023). Keloids.
Fabbrocini, G., Annunziata, M. C., Vita, V. D., Lodi, G., Mauriello, M. C., Pastore, F., & Monfrecola, G. (2010). Acne Scars: Pathogenesis, Classification and Treatment. Dermatology Research and Practice, 2010.
Ogunbiyi, A. (2016). Acne keloidalis nuchae: Prevalence, impact, and management challenges. Clinical, Cosmetic and Investigational Dermatology, 9, 483-489.

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