If you’ve noticed a scar that keeps growing beyond the edges of your original wound, feels itchy or tender, and doesn’t seem to be settling down, you may be dealing with a keloid. Keloid scars are common, often misunderstood, and highly manageable once you understand what’s actually happening in your skin. This guide covers what keloids are, why they form, who’s most at risk, and the treatment and home-care approaches supported by dermatology research.
What Is a Keloid Scar?
A keloid is a raised, fibrous scar that grows beyond the borders of the original injury. Unlike a normal scar, a keloid doesn’t stop at the wound edge — it spreads into surrounding healthy skin, can keep thickening for months or years, and tends to return even after it’s surgically removed. The name comes from the Greek word for “crab’s claw,” because some keloids send out clawlike extensions into the skin around them.
Keloids form when the skin produces too much collagen while healing a wound. Rather than switching off once the wound has closed, the collagen-building process keeps going, creating a lump of dense scar tissue.
Keloid vs Hypertrophic Scar — What’s the Difference?
Keloids are often confused with hypertrophic scars, and the two are treated quite differently, so it’s worth knowing which one you have:
- A hypertrophic scar stays within the boundaries of the original wound. A keloid spreads beyond them.
- Hypertrophic scars usually appear within a month of the injury. Keloids tend to take three months or longer to show up, and sometimes don’t appear for a year or more.
- Hypertrophic scars often flatten and fade on their own over time. Keloids typically don’t regress without treatment, and can keep growing for years.
If you’re not sure which type you have, a dermatologist can usually tell from a physical exam.
What Causes Keloids, and Who’s at Risk?
Keloids can develop after almost any skin injury — but some people are far more prone to them than others:
- Skin tone: People with darker skin — including Black, Hispanic, and Asian individuals — have a 15 to 20 times higher risk of developing keloids than people with lighter skin.
- Genetics: Keloids can run in families, and researchers have identified inherited patterns that raise the risk.
- Age: Risk is highest under age 30, and peaks between ages 10 and 20. Hormonal shifts, such as puberty or pregnancy, can also increase risk.
- Type of injury: Burns carry the highest keloid risk of any wound type. Other common triggers include acne, ear piercings, chickenpox, vaccination sites, biopsies, and cuts — particularly wounds that take longer than three weeks to heal.
Keloids most often appear on the sternum (chest), shoulders, upper arms, earlobes, and cheeks — areas where the skin is under more tension or where piercings and acne are common.
Symptoms
Keloids are often shiny, rubbery, and raised more than 4mm above the skin. Many people experience itching and pain, especially at the border where the keloid meets normal skin, and visible keloids — particularly on the face, chest, or ears — can be a source of real self-consciousness. You’re not alone in finding them frustrating, and there’s a lot that can be done.
Treatment Options
There’s no single “best” treatment for every keloid — the right approach depends on the size, location, and how established the scar is. A dermatologist or plastic surgeon can help you choose, but here’s what the research shows:
- Silicone sheeting: A non-invasive first-line option, typically worn 12–24 hours a day for two to three months. Case reviews report response rates of 50–100%, though researchers note that much of the underlying evidence is still of mixed quality. Silicone should only be used on fully closed, healed skin — never on an open wound.
- Pressure dressings or garments: Worn consistently for six to twelve months, these can achieve response rates of 90–100% in studies, but they require real day-to-day commitment to work. They’re most often used to prevent keloids forming after burns.
- Corticosteroid injections: Usually given monthly to every six weeks, these can flatten 50–100% of keloids, though 9–50% recur afterward. Possible side effects include thinning skin and lighter patches at the injection site.
- Cryotherapy (freezing): Best suited to small keloids, such as those from acne, with response rates of 50–76%. It can cause lightening of the skin, especially in darker skin tones.
- Surgery: Removing a keloid surgically on its own has a high recurrence rate (50–100%), because surgery is itself a new injury that can trigger another keloid. Combining surgery with steroid injections and silicone sheeting afterward (“triple therapy”) brings recurrence down dramatically, to around 12.5% in one study.
- Laser therapy: Can improve appearance by 57–83% in some studies, though results vary and it requires a trained specialist.
- Radiation: Reserved for stubborn, treatment-resistant keloids, usually combined with surgery, and carries a small long-term risk that your doctor will discuss with you.
Over-the-counter options like vitamin E or onion extract gels are popular, but the evidence behind them for keloids specifically is weak, and vitamin E can occasionally cause skin irritation.
Preventing a Keloid Before It Starts
If you already know you’re prone to keloids — because you’ve had one before, or because they run in your family — there’s a lot you can do before and after a planned injury:
- Tell your surgeon or piercer about your keloid history beforehand, if the procedure is planned.
- Start silicone sheeting or gel as soon as a wound has closed, rather than waiting to see if a keloid develops.
- Taping a healing wound to reduce tension on the skin for around 12 weeks may lower the risk.
- If you’re prone to keloids and have darker skin, it’s worth thinking carefully before getting ear piercings or other elective skin injuries.
Caring for a Keloid-Prone Scar at Home
Once a wound has fully closed and your healthcare provider has confirmed it’s ready, a daily silicone routine is the most evidence-backed home-care step you can take. Many people use a silicone gel such as our Rejuvasil Silicone Scar Gel or a silicone sheet from our Scar Fx Silicone Sheeting range as part of their everyday scar care, applying it consistently over several weeks to months. Consistency matters more than any single product — the research behind silicone therapy is based on regular, sustained use.
When to See a Dermatologist
It’s worth booking an appointment if a scar is growing beyond the original wound, is increasingly painful or itchy, is affecting your confidence, or if you’re planning a procedure and know you’re prone to keloids. A dermatologist or plastic surgeon can confirm the diagnosis and build a treatment plan suited to your scar and skin type.
This page is for general information only and isn’t a substitute for personalised medical advice. Please speak to a dermatologist or doctor before starting any new treatment, especially on a new or still-healing wound.
References
- Juckett G. “Management of Keloids and Hypertrophic Scars.” American Family Physician.
- British Skin Foundation, “Dealing with Keloid Scars.”
