Keloid Scars: Understanding Causes and Treatment Options

A few weeks after a piercing, your earlobe has a firm raised area that is getting bigger. Or the scar from an operation on your chest or shoulder thickens and spreads onto healthy skin. It may be a keloid scar. These are also called keloidal scars or, more simply, keloids. Keloid scars do not fade like other scars: the skin produces more scar tissue than it needs, and the scar spreads.

A treatment can reduce a keloid, soften it and make it less bothersome; no treatment guarantees that it will disappear or that it will not come back. Before choosing a treatment, the doctor checks that it really is a keloid. A photo is no substitute for this examination.

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In Brief

Five things to know before deciding

What it is: a firm, raised scar that extends beyond the boundaries of the injury and can keep growing for months or years.
How it differs: a hypertrophic scar stays within the area of the injury and is more likely to flatten; a keloid, on the other hand, tends to persist.
Who is affected: all skin tones, more often darker skin; the risk increases if you have had a keloid before or if keloids run in your family.
The options: injection into the keloid, silicone, pressure, applying cold, surgery, laser treatment, alone or in combination; none guarantees that the keloid will disappear, and it can come back.
When to have it examined: a scar that bleeds, does not heal or changes in appearance; the diagnosis is confirmed through an examination.

What a Keloid Is and How It Changes Over Time

A scar forms when the skin repairs itself: it produces collagen to close the wound. In a keloid, the body produces more collagen than it needs to heal, which is why the scar becomes larger than the injury that caused it. The exact mechanism is not fully understood.

It forms a raised area, often firm and smooth. Its colour varies: skin-coloured, pink, red, burgundy, or darker than the surrounding skin.

It does not always appear right away. It can show up three or four weeks after the injury, or only a year or more later, then grow for months or years. While it is growing, it can itch, sting or hurt; once it has stopped growing, the discomfort usually stops. Near a joint, it can limit movement. It tends to persist rather than disappear on its own.

Keloid or Hypertrophic Scar: The Difference

A hypertrophic scar is also raised and thicker than a typical scar, but it stays within the area of injured skin. It forms mainly when a wound heals under a lot of tension, and it is more likely to shrink over time. A keloid, on the other hand, spreads onto healthy skin and tends to persist.

Boundaries: a hypertrophic scar stays within the edges of the injury; a keloid extends beyond them.
Changes over time: a hypertrophic scar more often flattens on its own; a keloid can grow for months or years and does not go away.
Symptoms: a growing keloid can itch, sting or hurt, and limit movement near a joint.

This difference changes what you can expect. With a keloid, the question of whether the scar will come back arises from the start, and what is appropriate for a hypertrophic scar is not necessarily appropriate here. To choose treatment that is safe and suitable, the doctor needs to know the type of scar and your medical history. The difference is not always clear from appearance alone: the doctor determines which type it is on examination.

If yours stays within the boundaries of the injury, it may be a hypertrophic scar. It is more likely to flatten over time; expectations for treatment are not the same as for a keloid.

Where It Forms, Why, and Who Is Affected

A keloid develops after an injury to the skin, even a minor one: surgery (a C-section, for example), a burn, a piercing, a scratch. It more often follows a burn, acne, or a wound that became infected or that healed under a lot of tension on the skin. Not all acne scars are keloids: only some take this form. An acne breakout can leave a scar; acne that is still active also requires skin care.

Some areas are more at risk: the upper chest and breastbone, the shoulders, the chin, the neck, the lower legs and the earlobe, especially after a piercing.

Your medical history also matters. If you have had a keloid before, the risk increases with each new skin injury. The tendency can run in families, but it is not always passed on.

Keloids are also more common on darker skin: in people with black or brown skin, the scar looks pigmented rather than pink. However, they occur in all groups, and fair skin does not protect against them. Darker skin increases the risk, but this does not mean that an injury will necessarily lead to a keloid.

Treatments for Keloid Scars

A keloid is treated to reduce its raised profile and ease the discomfort it causes, including pain and itching. The choice depends on its size, location and thickness, your skin, your medical history and the treatments already tried. These options exist in medicine, but CARE MD does not present them as treatments it offers for keloids. The result varies from person to person. None of them is certain to make a keloid disappear, and none always prevents it from coming back.

Injection Into the Keloid

A prescribed treatment is injected directly into the scar, usually as a series of injections. Some prescribed injections can relieve symptoms, soften a keloid and reduce it. However, it can grow back after shrinking.

Depending on the treatment injected, the skin can become lighter or darker or thinner, or small blood vessels can become visible on the surface; the scar can also widen or come back. The number of sessions and how often they take place vary: you and the doctor decide on them based on how the scar responds. It is a medical procedure, performed by a physician, or a nurse injector supervised by a physician.

Silicone

Medical-grade silicone, as a gel or sheets, can help flatten a keloid. It is applied to skin that has healed over and must never be applied to a scab or an open wound. To work, a sheet has to be worn every day, often for months, and the skin can become irritated, develop a rash or break down under the dressing. Its effect on an established keloid remains very uncertain. It is not an ordinary moisturizer: this is medical-grade silicone, used on the scar itself.

Pressure

A pressure earring, a dressing or a compression garment is often used after a keloid is removed, to reduce blood flow to the scar and try to prevent it from coming back. These devices are usually uncomfortable and must be worn for much of the day for several months; the effect is not guaranteed.

Cryotherapy

Cryotherapy freezes the scar, which gradually destroys its tissue. It can reduce the size and hardness of a keloid and is mainly appropriate for small ones. The cold can be painful during and after treatment and cause blisters. On brown or black skin, it can leave a permanent light patch.

Surgery

Removing a keloid can be considered in certain situations. However, the operation creates a new wound that requires care until it heals, and the keloid grows back in the vast majority of cases when surgery is used alone, sometimes larger than before. That is why surgery is often combined with injections or pressure, which can reduce the risk of recurrence without eliminating it. Removing the scar therefore does not guarantee that it will not come back.

Laser Treatment

Laser treatment can reduce how raised a keloid is and make its colour less noticeable; it is often combined with other treatments, such as injections or pressure. The choice depends on skin type, the characteristics of the scar and general health. On tanned or sunburned skin, it can cause a severe burn or discolouration, and sun exposure on the treated skin can cause a new scar. If CO2 laser treatment is being considered, the procedure falls within the scope of practice of a physician, or a nurse supervised by a physician; this does not confirm that CARE MD offers it for keloids.

Other Options and Combinations

Radiation therapy can be considered after surgery to limit the return of the keloid. It can cause desquamation, meaning the skin peels, as well as itching and a lasting change in colour. A risk of cancer developing later must also be discussed with the specialist. Other prescribed treatments exist; the doctor decides which to choose.

Several treatments are often combined, but a combination is not always more effective: the choice depends on the scar.

Duration, Follow-Up and Recurrence

The number of sessions, the length of follow-up and the response vary from person to person. These become clearer over successive visits with the doctor. Whatever the option, the keloid can come back. One purpose of follow-up is to monitor for this common recurrence.

Creams, Massage and Natural Remedies

An emollient cream or oil, which helps keep the skin supple, can be used for comfort and applied with regular massage. This is no substitute for an examination or appropriate treatment. An ordinary moisturizer is different from medical-grade silicone: silicone is applied to skin that has healed over, and its effect on an established keloid remains very uncertain.

For a cream, an essential oil or a home remedy, ask what effect you can expect and how to monitor how well your skin tolerates it. Do not choose a product based only on the word “natural”. These remedies must not lead you to skip an examination of a growing scar or to wait for it to disappear.

Preventing a Keloid When You Are at Risk

If you have had a keloid before, or if someone in your immediate family has one, prevention starts before the injury. Before surgery, tell your surgeon that you or a close relative have keloids: the surgeon can take precautions that reduce the risk. For a piercing, a tattoo or surgery that is not essential, it is better to avoid it if possible; otherwise, make an informed decision.

After an injury, gently clean the wound and change the dressing every day until it heals, without rubbing, because rubbing can itself leave a mark on the skin. Preventive medication is not used routinely: whether it is useful depends on the wound; discuss it with a professional. Once the wound has closed, silicone can be considered. If a scar starts to thicken, have it examined early.

These precautions reduce the risk without eliminating it: a keloid cannot always be avoided.

When to Have It Examined

Growth that is clearly faster than usual should also be examined; a keloid usually grows slowly, over months or years. Bleeding or an open wound must not automatically be attributed to a keloid: other skin problems cause the same signs, and the doctor distinguishes between them on examination. These signs do not mean that it is cancer.

Preparing for the Examination

The diagnosis is confirmed in person, through an examination. Before the examination, note how long the scar has been there and how it has changed. Mention whether it itches, hurts or interferes with movement, whether you or anyone in your family has had a keloid, which treatments you have tried and how your skin reacted. Also say what you are hoping for: this allows the doctor to explain what a treatment can actually do.

To discuss your expectations, you can request a Global Aesthetic consultation at CARE MD in Sainte-Thérèse. If your scar requires a specialist's opinion, ask the doctor whom to turn to.

Living With a Keloid

A keloid can affect your well-being: through its appearance, through pain or itching, through the discomfort it causes in daily life. If the scar restricts your movements or hurts, or if you are troubled by it day to day, tell the doctor: support can be offered in addition to the examination of the scar, not instead of it.

A Question About Your Scar?

Describe where the scar is, how long it has been growing and what you have already tried, then ask CARE MD your questions. A message is no substitute for an in-person examination.

Frequently asked questions

Where and why does a scar become a keloid?

A keloid forms when the skin, while repairing itself after an injury, produces more collagen than it needs: the scar then grows beyond the wound. The injury can be surgery, a burn, a piercing, acne or a minor scratch. The areas most often affected are the upper chest, shoulders, chin, neck, lower legs and the earlobe after a piercing. The risk increases if you have had a keloid before, if someone in your family has keloids or if you have darker skin. This does not mean that an injury will necessarily lead to a keloid. Only the doctor, on examination, confirms that a scar is a keloid.

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