Keloid scars

What is a keloid?
A keloid is a type of raised scar. Unlike other raised scars, keloids grow much larger than the wound that caused the scar. Board-certified dermatologists have expertise in treating keloids.

Is a keloid contagious? No

Keloid scar on the back of a hand

Not everyone who gets a scar will develop a keloid.

In what race are keloids most common?

People of all races get keloids. Findings from studies, however, suggest that Black people have the greatest risk of developing keloids. People of Asian, Latin American, or Mediterranean descent are more likely to develop keloids than people who have a lighter skin tone.

Why are keloids more common among people who have a darker skin tone?

Researchers have found that between 33% and 50% of people who develop a keloid have at least one blood relative who gets keloids. This suggests that some people inherit genes that make them more likely to develop keloids.

Dermatologists have found that these genes are more common in people who have a darker skin tone. In the United States, Black people are most likely to have one or more blood relatives who get keloids.

When do keloids appear?

A keloid usually takes time to appear. After you injure your skin, months can pass before this scar appears. Once it begins, a keloid tends to grow slowly for months or years.

This slow growth differs greatly from the other type of raised scar called a hypertrophic scar.

If you have a hypertrophic scar, it appears one to two months after you wound your skin and the scar tissue doesn’t grow beyond the wound. With time, a hypertrophic scar often becomes less noticeable.

While keloids tend to develop slowly, some appear more quickly.

Do keloids go away?

Unlike a hypertrophic scar, a keloid doesn’t fade with time. To reduce the appearance of a keloid, you need to treat it.

When it comes to treatment, no one treatment works best for all keloids. That’s why dermatologists consider where the keloid appears on your body, its size, and how deeply the keloid penetrates your skin.

Your age and how you responded to past treatment for a keloid also help determine what type of treatment would give you best results.

Do keloids hurt?

While a keloid is growing, it can cause pain or discomfort. The pain usually goes away when the keloid stops growing.

On rare occasion, keloids can remain tender and painful.

Can a keloid turn into cancer?

No, keloids do not turn into cancer.

What do keloids look like?

The size and shape of keloids vary. On an earlobe, you’ll likely see a round, solid mass. When a keloid forms on a shoulder or the chest, the raised scar tends to spread out across the skin. It often looks like a liquid spilled on the skin and then hardened.

Where do keloids develop on the body?

Most develop in one of these areas:

• Ear or earlobe

• Jawline

• Chest

• Upper back

• Shoulder

Because a keloid develops after you injure your skin, you can get this scar elsewhere. For example, a woman who has keloid-prone skin can develop a keloid on her belly after having a cesarean section (C-section), hysterectomy, or other surgery in this area.

Navel piercing can also cause a keloid on the belly.

Men who have darkly pigmented skin and shave their beard area may develop keloids on their face.

It’s rare for a keloid to develop on the genitals, palms, soles, or tongue.

How do keloids develop?

You’ll likely notice one or more of the following, as this scar forms:

Appears slowly

After you injure skin, it’s likely to take 3 to 12 months or longer to see the first signs of a keloid. The first sign is usually thickening skin. About 20% of keloid scars appear more than a year after the injury.

Grows

When it began, the keloid on this girl’s earlobe looked like a pimple. It continued to grow. Most keloids continue to grow for weeks or months after they appear. A few grow for years. Growth tends to be slow. Occasionally, a keloid grows quickly.

Causes pain, itch, or burning

While a keloid is growing, it may feel tender or painful. It may itch or cause a burning sensation. Symptoms tend to end when the keloid stops growing, but not always. This man developed keloids on his face after chickenpox cleared. Decades later, the keloids still itch and feel painful.

Changes color

The color of a keloid, like the one on this patient’s shoulder, can differ from that of your natural skin color. When a keloid first appears, it’s often red, pink, or slightly darker than your natural skin tone. As it grows, it may darken. Some become lighter in the center and darker at the edges.

Darkens after spending time in the sun

Some people say their keloid darkens noticeably after they spent time in the sun. This darkening can be permanent.

Stops growing

Once a keloid stops growing, it tends to remain the same size. Unlike other scars, a keloid rarely fades without treatment.

Keloids have different shapes, sizes, and textures

The keloid you see on your skin can look different from the keloid you see on someone else’s skin. Sometimes, one keloid on your skin will look very different from another. The following pictures of keloids show how different keloids can look.

Shape of keloids varies

Most keloids are either round, oval, or oblong. On the chest, arms, or legs, this scar is usually raised and has a flat surface. A keloid on the ear, neck, or belly may hang from the skin.

Size differs

A keloid can range from the size of a pimple to larger than a football.

Texture often hard and rubbery or soft and doughy

When you touch a keloid, you’re most likely to feel one of these textures. A few keloids have a texture that’s somewhere in between hard and soft.

Number of keloids varies

Most people develop one or two keloids. Some people get several. You’re more likely to develop many keloids after acne or chickenpox clears, but not always. The girl in this picture developed two keloids after chickenpox cleared.

Problems that keloids can cause

While most keloids are harmless, they can interfere with your life. A keloid can:

Restrict how far you can move or stretch

When a keloid covers a large area or develops over a joint, the hardened, tight scar tissue often limits how far you can move. If this happens, it may affect your ability to reach, walk, and do other activities.

Bleed or become infected

A keloid rarely opens upon its own. Like the rest of your skin, you may see a keloid bleeding if you injure it. An open keloid can become infected. If the wound on a keloid fails to heal, see a dermatologist.

Leave you feeling sad or upset

Having a keloid can be hard on your self-esteem. These scars can be noticeable. Most people who seek treatment for a keloid do so because they dislike what it looks like.

What causes keloid scars?

Anything that causes skin to scar can cause a keloid.

If you have keloid-prone skin (not everyone does), this scar may form after a:

• Body piercing (especially ear piercing)

• Bout with acne or chickenpox (usually developing on the face, chest, or back)

• Burn

• Cut, scrape, or bug bite

• Deep wound like a puncture wound

• Skin disease that causes inflammation like folliculitis

• Tattoo

• Wound caused by surgery, a procedure, or an injection

Some people get a keloid when they shave their beard area.

It’s also possible for a keloid to appear on uninjured skin. This keloid is called a “spontaneous keloid.”

Spontaneous keloids are rare, so there are only a few known cases. Findings from studies suggest that these keloids may occur when:

• The skin injury is so minor that the person doesn’t notice it.

• A disease causes intense inflammation inside the body.

• Certain medication is taken.

Exactly what happens inside the body to cause keloids isn’t fully understood. Researchers know that the body produces more collagen than its needs to heal the injured skin. That’s why the keloid scar grows bigger than the wound that caused it.

To understand all that happens inside the body, dermatologists continue to study keloids.

Does melanin cause keloids?

Melanin is the pigment that gives our skin, hair, and eyes their color. The more melanin your body produces, the darker your skin, hair, and eyes.

Researchers have been studying what role, if any, melanin plays in causing keloids because:

• Black people have more melanin than other races, and they are more likely to develop keloids than white people.

• When we injure our skin, the body produces cells that make pigment (melanocytes). This means there’s more melanin in the injured area.

• Keloids are more likely to develop on areas of the body that have more melanocytes (cells that make pigment). For example, a keloid is more likely to form on the chest than the palm of the hand.

These facts certainly suggest that melanin might play a role in causing keloids.

Some people are more likely to get keloids

In the United States, Black people between the ages of 10 and 30 have the greatest risk of developing a keloid.

Researchers continue to study keloids to find out what causes them. Knowing exactly what causes this type of scar could lead to better treatment and more effective ways to prevent keloids.

What increases the risk of developing keloids?

While studying what causes keloids, dermatologists learned that certain people seem more likely to develop these scars. Here’s what seems to increase the risk:

• African, Asian, or Latin-American descent: In the United States, keloids are more common in Black and Latin Americans than people with lighter skin tones. Whereas, in Asia, ethnic Chinese have the highest risk of developing keloids.

• Family history of keloids: About one-third of people who get keloids have a first-degree blood relative (mother, father, sister, brother, or child) who gets keloids. This is most common in people of African or Asian descent.

• Age (10 and 30 years old): This is the peak time to develop keloids. Most people begin seeing keloids in their 20s. However, a keloid can develop at any time. Infants get keloids. People 70 years of age or older develop keloids.

• Pregnancy: The hormonal changes that occur during pregnancy increase the risk of developing a keloid.
  

Many people who have keloids want to know about treatment. A keloid can feel uncomfortable, itchy, or painful. If a keloid develops over a shoulder or other joint, it can limit how far you can move. Many people simply dislike the way keloids look.

Here’s what you can expect when you see a board-certified dermatologist for treatment.

How do dermatologists diagnose keloids?

A dermatologist can usually diagnose a keloid by looking at it.

Sometimes, another skin condition can look like a keloid. For example, if someone has an allergic skin reaction to the gold in their earrings, the swelling can look like a keloid.

If it looks like you might have another condition, your dermatologist can perform a skin biopsy. This is a simple procedure that your dermatologist can perform during your office visit. You remain awake the entire time.

To perform a skin biopsy, your dermatologist numbs the area and removes a small amount of skin so that it can be examined under a microscope.

Your dermatologist sends the removed skin to a medical lab. The doctor who examines what your dermatologist removed will write a report. It tells your dermatologist what was seen under the microscope.

If you have a keloid, your dermatologist can create a treatment plan tailored to your needs.

How do dermatologists treat keloids?

To give their patients the best results, dermatologists often recommend more than one type of treatment for a keloid. These scars can be difficult to get rid of, and some return after treatment. Using two or more types of treatment often improves results.

Before your appointment with a dermatologist: It’s helpful to think about what you expect from treatment. For example, how would you answer the following questions:

• Is easing a symptom like pain or itch most important to you?

• Will flattening or softening the keloid help you feel better?

• If you have a keloid on your ear, is your primary goal to wear earrings again?

Knowing what you expect will help your dermatologist provide you with realistic information about what treatment can do. It will also help your dermatologist create your treatment plan.

If you’ve had keloid treatment before, make sure your dermatologist knows

It’s important for your dermatologist to know how your skin responded to the previous treatment.

A treatment plan for keloids may include:

Injections of corticosteroids or another medication: These injections are often part a treatment plan for keloids. When injected into the keloid, these medicines help to shrink the scar.

Patients usually receive a series of injections. The first injections tend to relieve symptoms and make the keloid feel softer.

Between 50% and 80% of keloids shrink after being injected. Many of these keloids, however, will regrow within five years. To improve results, your dermatologists may follow these injections with one or more treatments like keloid surgery or prescribe a pressure garment.

Corticosteroid injections can be especially helpful for a keloid on an ear. When you have a keloid on an earlobe, it may also be helpful to wear a special earring that puts pressure on the earlobe. Called a pressure earring, it can help to prevent the keloid from returning.

If you have a darker skin tone, a possible side effect of corticosteroids injections is light spots developing where you get these injections. To prevent this, there are other medications that your dermatologist can use.

Keloid surgery: Your dermatologist can surgically cut out the keloid. While this may seem like a permanent solution, it’s important to know that nearly 100% of keloids return after this treatment.

To reduce the risk of a keloid returning after surgical removal, most patients have another treatment after surgery. Wearing a pressure garment or getting cryosurgery (see below) can help reduce the risk of a keloid returning.

To help reduce the risk of a keloid returning after surgery, some patients receive a series of corticosteroid injections before surgery. For example, a dermatologist may give you injections of corticosteroids every 2 to 3 weeks for four sessions before surgery.

Pressure earring, dressing, or garment: Often used after keloid surgery to reduce blood flow. This may stop a keloid from returning.

Using a pressure earring or garment as directed, however, can be difficult. These devices tend to be uncomfortable. To get results, a patient must wear the device for 12 to 20 hours a day for several months.

A pressure earring tends to be easiest to wear.

Silicone gel sheets: Made from medical-grade silicone, these sheets may help to flatten a keloid. For this reason, silicone gel sheets may be applied to a new keloid or applied after an injury to prevent a keloid from developing.

When using silicone gel sheets, never apply one to a scab or open wound

Once these heal, you can start using the silicone gel sheet.

Dermatologists also include silicone gel sheets in a treatment plan. They can help prevent a keloid from returning after another treatment like keloid surgery.

Freezing (cryosurgery): If you have darkly pigmented skin, this may not be recommended. Cryosurgery can cause a permanent light spot on brown or black skin. If your dermatologist recommends cryosurgery, a very cold substance will be used to freeze the keloid from the inside out while saving the skin beneath the keloid. This can reduce the hardness and size of a keloid. Cryosurgery works best on small keloids.

Because using a combination of treatments often works best for treating keloids, cryotherapy may be used after keloid surgery. Cryosurgery is usually performed about two weeks after you have your stitches removed. It can help reduce new scar tissue from forming.

Cryosurgery is also recommended before (or after) receiving injections of corticosteroids. Cryosurgery may reduce the size of a keloid, which can make the injections more effective.

Dermatologists have found that patients who have three or more cryosurgery treatments tend to get the best results.

Laser treatment: This can reduce the height and fade the color of a keloid. It’s often used along with other treatment like a series of corticosteroid injections or pressure.

Radiation treatments: For more than 100 years, radiation has been used to help prevent a keloid from growing back after you’ve had another treatment like surgery.7,10,11 Sometimes, radiation is the only treatment used; however, this is less common today.

While radiation treatments can help, this treatment has drawbacks. It can be hard on your skin, causing peeling, itching, and permanent skin color changes. There also have been reports of patients developing cancer many years after having radiation treatment for keloids.2,3

Dermatologists take these reports seriously. Because the reports lacked essential details like how much radiation each patient received and the safety measures that were taken to protect the patient, dermatologists reached out to oncologists (cancer doctors) for more information.

What they found suggests that a type of treatment called superficial radiation therapy (SRT) can be used after keloid surgery (or another treatment) to reduce the risk of a keloid returning. SRT is appropriate when safety measures are taken to reduce the cancer risk. These measures include using the right dose of radiation and protecting areas of the body that don’t need radiation treatment.9

Ligature: If a surgical thread can be tied around the keloid, your dermatologist may recommend this treatment. The surgical thread will gradually cut into the keloid, which can cause it to fall off. You’ll need to tie a new surgical thread around the keloid every two to three weeks.

New and innovative options for treating keloids

No treatment can consistently get rid of a keloid. What works for one patient may have no effect on another patient. There is not a treatment that will always prevent a keloid from returning after it’s treated.

For these reasons, dermatologists are working to better understand what causes keloids and develop more effective treatment. Never before have there been so many treatment options in development.

If one of these newer treatments could help you, your dermatologist may talk with you about it, especially if other treatments have not helped.

What can improve results after keloid treatment?

How you care for your skin can make a difference. Be sure to follow the at-home care that your dermatologist gives you. You also want to stick to your treatment plan, getting all treatments that your dermatologist recommends.

How to prevent a keloid

If you have keloid-prone skin, you cannot always prevent a keloid. By taking precautions, you may reduce your risk of getting a keloid.

Here are four common causes of keloids and what dermatologists say can prevent (or at least reduce the size of) a keloid.

1. Ear piercing: The ear is a common place to get a keloid. If you or blood relatives have had a keloid, you may develop a keloid after piercing any part of your ear. The best way to prevent a keloid is to skip getting a piercing on any part of your ears.
   
   If you still want to try a piercing, here’s what can help reduce your risk of developing a keloid on your ear.
   
   Pay close attention to your ears after getting a new piercing. If you notice the skin on an earlobe start to thicken, you may be able to prevent a keloid if you act quickly. At the first sign of thickening, immediately remove the earring and start wearing a pressure earring instead.

   This girl developed a keloid after getting her ears pierced

   She may have prevented this keloid if she had worn a pressure earring immediately after she noticed her skin start to thicken.

   You’ll find pressure earrings available online.
   
   To get the best results from a pressure earring, you must start wearing it as soon as the skin starts to thicken, and you must wear it for at least 12 (and preferably 20) hours a day for 4 to 6 months.
   
   Because you cannot wear another earring under a pressure earring, a new piercing may close. Dermatologists caution against getting your ears pierced again. You may develop another keloid.

2. Tattoo, body piercing, or cosmetic procedure: These all injure the skin, which means you could develop a keloid afterward if you’re prone to getting keloids. The best way to prevent a keloid is to skip the body art and cosmetic procedures.
   
   If you have your heart set on getting one, here’s what can help.
   
   Try a test spot first. To test a tattoo, piercing, or procedure, start small. For example, if you want a tattoo or body piercing, start by getting a small tattoo or one body piercing.
   
   If you’re concerned that a cosmetic procedure may cause a keloid, tell your dermatologist or other doctor who will perform the procedure. Your dermatologist may recommend another treatment option or try a test spot.
   
   By starting small, you can watch for thickening skin. This is the first sign of a keloid.
   
   If the skin in the test area starts to thicken, you want to start wearing a pressure earring or pressure garment immediately. Pressure can prevent the thickening skin from turning into a keloid.
   
   To be effective, you need to start with the pressure as soon as you notice thickening skin. A dermatologist can fit you with a pressure garment or earring. Adding another keloid treatment like injections of corticosteroids may also help.

3. Surgery, including dental surgery: A keloid can develop on your skin or inside your mouth. When you need surgery, here’s what can reduce your risk of developing a keloid:

   • Tell your surgeon before the surgery that you or a blood relative develop keloids. Your surgeon may be able to take precautions that can reduce your risk of developing a keloid. Having keloid treatment after surgery can also help.

   • Pay close attention to the scar left by surgery. If you notice it thickening, contact a dermatologist right away. A dermatologist may be able to prevent the thickening skin from becoming a keloid.

4. Skin injury: Even a minor wound like a scrape or bug bite can cause a keloid. If you have had a keloid or they run in your family, proper wound care may help prevent a keloid.
   
   Here’s what dermatologists recommend:
   
   Supplies you need
   You’ll want to have the following on hand:

   • Sterile petrolatum gauze or hydrogel wound dressing

   • Silicone gel sheets or silicone gel

   • Sunscreen with SPF 30 or higher, broad-spectrum protection, and water resistance

   
   If you injure your skin, follow these steps:
   
   

   • Wash the injured skin immediately with soap and water. Even a minor wound needs this care.
     
     Keeping the wound clean helps to reduce scarring. Using soap and tap water or a saline solution will cleanse the wound without drying it.
     
     Avoid using hydrogen peroxide, rubbing alcohol, or iodine, which can dry the wound.

   • Bandage the area with hydrogel wound dressing or sterile petrolatum gauze. You want to keep wounds moist. Moisture helps to speed up wound healing.

   • Gently cleanse the wound and apply a new wound dressing or gauze every day until the wound heals. When cleansing the wound, you want to avoid scrubbing, which can cause a scar.

   • If you have a severe injury like a bad burn, seek medical care

     This can give you the best outcome.

   • After the wound heals, apply silicone gel sheets or silicone gel. You can buy both of these products without a prescription. They can help prevent a keloid. To get the best results, you apply a new sheet or gel to the area every day.
     
     You need to wear this every day for about six months. If the wound hasn’t increased in size by this time, you can usually stop wearing the silicone sheets or gel. If you’re unsure when to stop, see a board-certified dermatologist.

   • Protect the injured area from the sun. After the wound heals, you won’t see a keloid right away. Keloids take time to appear.
     
     To reduce your risk of developing a keloid, you need to protect the area from the sun. Covering the area with clothing can help. If clothing won’t cover the area when you’re outdoors, use sunscreen.
     

     Protect area from the sun

     If you have brown or black skin, dermatologists recommend using a tinted sunscreen. It won’t leave a white residue on your skin.

     To get the protection you need, use a sunscreen that offers SPF 30 or higher, broad-spectrum protection, and water resistance.
     
     To be effective, you must apply sunscreen 15 minutes before going outdoors.