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Grows beyond the wound and does not recede by itself — that is what sets it apart from every other scar.
Also known as: keloid · hypertrophic scar (to be distinguished) · overgrown scar
Open in the tool — with search and all the links →This compilation is for information and replaces neither medical diagnosis nor treatment. If you have symptoms, see a doctor.
A scar that grows beyond the original wound and no longer recedes by itself. That is the whole difference from a hypertrophic scar: the latter stays within the wound borders and flattens over one to two years, a keloid does neither. It arises because the repair does not stop — the connective tissue cells keep producing collagen although the wound closed long ago. Preferentially on the breastbone, shoulders, upper arms, jaw angle and earlobes; preferentially between ten and thirty; and five to fifteen times more common on dark skin than on light. The trigger is any skin injury, however small: an ear piercing, an acne spot, a needle prick, a cut. Keloids are benign — they itch, burn, feel tight and get in the way, but they do not spread.
A hypertrophic scar stays within the wound borders and flattens by itself in one to two years. A keloid grows beyond them and does not recede. Mixing the two means either waiting in vain for an improvement that will not come — or treating something that would have settled on its own. A look at the edge of the original injury usually answers the question.
Silicone sheets or gel have been the first measure for decades, not because they act strongly but because they hardly harm. Studied at 12–24 hours a day for at least 2–3 months, better 6. How it works is not fully settled — probably through the moisture under the sheet rather than the silicone itself. The evidence is weaker than the widespread use suggests; it is simply better than that for any alternative.
Pressure of 15–25 mmHg for 23 hours a day, usually 6–12 months. In burn scars this has been standard for decades; for earlobes there are pressure clips. The difficulty lies not in the effect but in keeping it up — most people give up in the first eight weeks.
Triamcinolone 10–40 mg per ml, injected into the scar itself, every 3–4 weeks over several sessions. The scar flattens markedly in most people and the itch often eases after the first injection. Recurrences occur in 9–50 %. The most common side effects are a dent and fine widened vessels at the injection site, plus lightening that shows on dark skin and lasts months.
The operation creates exactly what triggered the keloid: a new wound. Performed alone it comes back in 45–100 % of cases, often larger than before. With follow-up treatment — radiation within 24–48 hours, steroid injections or pressure over months — recurrence falls to about 10–20 %. That is why what comes afterwards belongs settled before any procedure.
Freezing from inside — with a needle in the tissue rather than spraying the surface — works better than surface application and lightens the skin less. The dye laser mainly takes the redness and the itch. In comparative studies combinations do best: steroid together with 5-fluorouracil acts more strongly than steroid alone and needs fewer sessions. There is no single method here that fits everyone.
The most common case in young women, and the one with the best outlook: on the earlobe the keloid can be cut out and then treated with a pressure clip for 6–12 months. The recurrence rate is then markedly lower than elsewhere. Anyone who has developed a keloid on one side will very likely get one on the other — that belongs said before the second piercing.
The most common trigger of all, and it has its own names: at the back of the head acne keloidalis nuchae, in the beard pseudofolliculitis barbae. Both arise the same way — a curly hair is cut very short, grows tip-first back into the skin and is treated there as a foreign body. The small bump becomes a firm plaque over months, and at the nape the hair beneath it stops growing. Almost only people with curly hair are affected, mostly men, mostly from the age when the beard comes in. Here lies the one point where prevention genuinely works: at the nape do not cut shorter than about three millimetres and do not clip against the direction of growth, avoid rubbing collars and helmet edges; in the beard do not shave to zero, do not stretch the skin while shaving, go with the grain. Permanent hair removal by laser is the treatment with the best evidence — no hair, no trigger. And the early bumps still respond well to an ointment; the finished plaque does not. Treating the first bump instead of waiting prevents what is seen later.
Anyone who already has a keloid will very likely get another with the next injury. In practice: no piercings or tattoos on the breastbone, shoulders and jaw angle; treat acne early rather than squeezing it; discuss the incision line before planned procedures; and from the moment the wound is closed start silicone at once rather than waiting to see whether something grows.
Silicone keeps the scar moist and flatter; it does not dissolve it. Steroid slows the connective tissue cells and takes the itch; it does not remove the keloid and can leave a dent. Pressure shapes over months; it works only while it is on. Surgery removes the tissue and at the same time sets the stimulus for the next one — alone it rarely helps. Onion gel and vitamin E sell well and are poorly supported; vitamin E causes contact dermatitis in a third. And no remedy makes a scar invisible — the goal is flatter, paler, softer and no longer itching.
Five to fifteen times more common on dark skin. Peak between 10 and 30 years. Onset usually 3 months to 1 year after the injury, sometimes later. Growth over months to years, without spontaneous regression. Silicone 12–24 hours a day, at least 2–3 months, better 6. Pressure 15–25 mmHg, 23 hours a day, 6–12 months. Steroid 10–40 mg per ml every 3–4 weeks; recurrence 9–50 %. Surgery alone: recurrence 45–100 %; with follow-up treatment 10–20 %; radiation within 24–48 hours of the incision. Every treatment becomes judgeable after 3 months, not after 3 weeks — the colour keeps changing over 12–24 months.
The one sign that counts. A hypertrophic scar stays within the original line, a keloid pushes sideways into healthy skin — often with claw-like extensions. This distinction decides the entire treatment.
The beginning, before it becomes a plaque. They look like spots, sit at the border between hair and neck and come back after every haircut. At this stage almost everything is still possible — an ointment, and a change of cutting technique. Wait, and over months they merge into a firm plaque, and then only surgery remains.
In about half. The itch comes from nerve fibres growing into the expanding tissue and is often what bothers most — more than the appearance. It eases as the keloid flattens.
Fresh it is red and soft, over the years it grows paler and firmer. The colour says something about age, not about activity — even a pale keloid can still be growing.
Over a joint or on the neck a larger keloid pulls the skin together. That is the point where a cosmetic problem becomes a physical one — and where treatment becomes more pressing.
In surveys those affected report limitations in daily life, in choosing clothes and in contact with others that bear no relation to the size. That belongs in the assessment, not at the end of it.
A keloid does not spread and does not turn malignant. But if an existing scar changes — hardens in depth, breaks open, bleeds without cause — it belongs looked at. Very rarely a skin tumour arises in old scars.
For healing after a procedure. It does not act on the keloid itself — that arises precisely because too much is being built, not too little.
Needed for collagen cross-linking. A deficiency delays wound healing; an excess does not speed it up and does not prevent a keloid.
With a proven deficiency the wound heals less well. Zinc preparations against keloids have been studied without a reliable result.
The best-selling scar gel. Reviews find small effects at most, and in comparisons it does worse than silicone. Using it costs nothing but time and money — as long as it does not replace the silicone.
Worthwhile with a proven deficiency and during healing after a procedure. As a treatment for the keloid itself it is not studied.
Keloids arise preferentially between puberty and thirty, and existing ones often grow further in pregnancy. After menopause new ones rarely form — that is one of the clearest patterns of this scar type.
Cortisone injected directly into the scar is the treatment with the most data — every four to six weeks, over months. It slows collagen formation exactly where too much is being made.
Growth signals drive the overshooting collagen formation. That is one of the explanations why keloids arise in the growing years and not in old age.
No food and no elimination diet influences whether a keloid forms or grows. Said plainly, because a lot is offered online. What counts is treatment on the skin and time.
1.2 g protein per kg body weight a day in the weeks after an operation, plus enough vitamin C. That supports healing of the new wound — it does not prevent recurrence.
Nicotine narrows the small vessels in the skin. Before a planned procedure four weeks without is the studied frame — it measurably reduces wound healing problems.
Scar massage is studied with small effects on suppleness and itch. Studied at 5–10 minutes twice daily over months — started only once the wound is fully closed.
The most widespread home remedy for scars — and one of the few where the studies are clear. In a controlled trial nothing improved, and about a third developed contact dermatitis that made the scar look worse.
Cools and eases the itch for a while. It does not act on the tissue itself — relief, not treatment.
Swallowing collagen to improve a scar made of too much collagen — the reasoning runs the wrong way. No benefit is shown.
Traditionally used for scar care. There is no proof of effect for keloids; none of it belongs on fresh, still open wounds.
In cell experiments curcumin slows the keloid’s connective tissue cells. In humans this is untested — the path from test tube to skin is long here, and swallowed it barely reaches the scar.