Keloid scars

Also called Hypertrophic scars, Raised scars

Scars that grow beyond the original wound. Much more common on brown and black skin, and prevention is far easier than treatment.

What it is

Scars in which the healing response overshoots, producing raised, firm, sometimes itchy or painful tissue.

A hypertrophic scar stays within the boundary of the original wound and often improves over a year or two. **A keloid grows beyond the original wound edges**, does not regress, and can continue enlarging for years.

Keloids are considerably more common in people with brown and black skin, and in younger people, and they run in families. Common sites are the earlobes after piercing, the chest, shoulders, upper back and jawline.

They matter beyond appearance: they itch, they can be painful, they restrict movement across joints, and their effect on confidence and identity is significant and frequently dismissed as cosmetic.

**Prevention is far more effective than treatment.** In somebody with a history of keloids, avoiding unnecessary piercings, tattoos and elective surgery on high-risk sites, and using silicone gel or sheeting and pressure on any new wound from around two weeks after healing, prevents a great deal.

Treatment is difficult and recurrence is common: steroid injections, silicone, pressure, cryotherapy and, for selected cases, surgery combined with post-operative radiotherapy or injections. Surgery alone usually makes the keloid larger.

Access to treatment is patchy because it is often classed as cosmetic, which is a real inequity given who is most affected.

Signs you might notice

A raised, firm, smooth, shiny scar.

Growing beyond the original wound margin, in a keloid.

Red, purple or darker than surrounding skin, becoming paler over years.

Itching, tenderness or a burning sensation.

Restriction of movement where it crosses a joint.

Continuing to grow over months or years rather than settling.

Common after ear piercing, acne on the chest and back, surgery, burns, chickenpox and vaccination sites.

See a GP for: a scar that is growing, itchy, painful or restricting movement; a scar that is bleeding, ulcerating or changing in an unusual way, which needs assessment for something else; or before any planned surgery or piercing if you have a keloid history.

How it can affect day-to-day life

Being told it is cosmetic is the standard experience, and it misses the itch, the pain and the psychological impact, which are all real and which are legitimate reasons for treatment.

Silicone gel or sheets, used consistently for months on a new scar, is the best-evidenced simple measure and needs 12 to 24 hours a day of contact to work.

Massage of a healing scar, and sun protection, both help; sun exposure darkens scars persistently.

Pressure earrings after earlobe keloid removal are essential to prevent recurrence and are often not supplied.

For anyone with a keloid tendency, saying so before any procedure allows the surgeon to plan incisions and post-operative care differently.

Acne on the chest, back and jawline should be treated actively in people prone to keloids, because keloid formation from acne is common and preventable.

Recurrence after treatment is common, and expectations need to be honest rather than optimistic.

Supporting someone well

Tell any surgeon, dentist or piercer about a keloid history before any procedure.

Avoid unnecessary piercings and tattoos on high-risk sites if you are prone.

Start silicone gel or sheeting on new wounds about two weeks after healing, and use it consistently for months.

Protect scars from the sun.

Treat acne on the chest, back and jawline actively if prone to keloids.

Ask for steroid injections for an itchy, painful or growing keloid.

Do not have a keloid excised without a plan for preventing recurrence.

Ask for pressure earrings after earlobe keloid surgery.

Say clearly if it itches, hurts or restricts movement; that is not cosmetic and it changes access to treatment.

Where to get help

A GP practice for assessment, injections and referral.

Dermatology or plastic surgery for treatment.

British Association of Dermatologists publish a patient leaflet on keloid scars.

Changing Faces support people with visible differences.