Keloids: when the scar grows more than expected

A straightforward and calm explanation of keloids: what triggers them (from piercings to surgery), how they typically develop, and what options exist for managing them. The goal is for you to understand your scar, make informed decisions, and know exactly when it’s worth seeking a professional evaluation.

Summary in 60 seconds

A keloid is an «exaggerated» scar: instead of staying within the wound’s border, it grows beyond it and can continue to increase in size over time. It commonly appears after common injuries (acne, piercings, surgery, cuts, burns). It can itch, hurt, or be irritated by friction, and in areas near joints, it can even restrict movement. It is not cancer and does not transform into cancer, but it can affect quality of life. Treatment aims to flatten, soften, and reduce symptoms; it often requires several sessions and combinations of techniques (for example, injections and pressure or silicone implants).

Surgery alone often leads to recurrence, so it is reserved for selected cases and almost always requires additional treatment. NHS 2023 American Academy of Dermatology Association 2022

What is it?

A keloid is a raised, firm scar that extends beyond the boundaries of the original wound . Unlike a hypertrophic scar (which is also raised), a keloid tends to invade surrounding skin and can persist or grow for months or years. British Association of Dermatologists 2017

Why does it appear? (common causes)

The most widely accepted explanation is that, in some people, skin repair after an injury becomes dysregulated: inflammation and collagen production are prolonged, leading to excessive scarring. This is not solely dependent on the size of the wound; sometimes even a small injury (such as a piercing) can act as a trigger. Ogawa 2017

Factors that increase risk (they guide, but do not determine):

• Personal history of keloids: if you have already had one, the risk of recurrence increases.

• Young age (approx. 10–30 years) and pregnancy are more likely to be associated.

• Certain ethnic origins and more pigmented skin types are more frequent (for biological/genetic reasons, not due to inadequate «care»).

• Typical areas: chest, shoulders, back, jaw/chin, neck, and earlobes. NHS 2023

What does it look like and what symptoms does it cause?

A keloid usually looks like a bump or plaque:

• Raised, firm, sometimes shiny and hairless on the surface.

• It can be skin-colored, pinkish/reddish, purplish, or darker than the surrounding skin.

• It may itch , hurt, or be sensitive to touch.

• It may continue to grow for months or years; near a joint it may cause discomfort when moving. NHS 2023

A practical point: if a scar grows only within the edge of the wound and tends to improve over time, it is more likely to be hypertrophic. If it grows beyond the edge and persists, a keloid is more likely. Royal Free London NHS Foundation Trust 2024

What can you do today? (safe and concrete measures)

1. Avoid traumatizing the area
   Do not scratch, pinch, or «rub hard» trying to flatten it: microtrauma can maintain inflammation and worsen symptoms.

2. Protect the scar from the sun
   UV radiation does not cause keloids, but it can intensify the color contrast between the scar and the surrounding skin, which is often a concern, especially in visible areas. Daily sun protection of exposed areas is a reasonable precaution. American Academy of Dermatology Association 2023

3. Medical-grade silicone when the skin is closed
   Silicone sheets or gels are widely used as support for problematic scars. Key: Do not apply to open wounds or active scabs ; use when the surface is closed and continuously for weeks/months as directed. Juckett 2009

4. If the cause was acne or folliculitis, treat it soon.
   It’s not just about aesthetics: reducing breakouts reduces new lesions on skin that is prone to excessive scarring. If your acne is leaving raised scars, it’s advisable to seek medical evaluation.

5. If it was a piercing and you notice progressive thickening
   Avoid harsh home remedies. Early evaluation helps: in some cases, pressure measures (e.g., earlobe devices) and staged treatments are considered. American Academy of Dermatology Association 2023

What NOT to do? (common mistakes)

• Do not cut, puncture or “drain” the lesion at home: it increases the risk of infection and can enlarge the keloid.

• Do not use repeated irritants (acids, homemade cauterizations, essential oils) with the idea of «burning it off»: chronic irritation can worsen the outcome.

• Do not rely on surgery as a “definitive solution” : excision without complementary measures is associated with recurrence; therefore, if surgery is performed, it is usually accompanied by adjuvant therapy (injections, pressure, cryotherapy, laser, and, in selected cases, superficial radiotherapy). Gold 2014

When should I consult?

Consult a healthcare professional (ideally a dermatologist or plastic surgeon experienced in scar treatment) if:

• The lesion grows rapidly or continues to grow for months.

• There is significant pain , very limiting itching, or marked sensitivity.

• Bleeding, ulceration, suppuration, foul odor, or fever may appear.

• It is in or near a joint and there is functional limitation .

• There is no clear prior injury or you have diagnostic doubts .

• Keloids recur after previous treatments. NHS 2023

What does a dermatologist usually do?

The evaluation is usually clinical: history (what injury started it, how long it has lasted, symptoms) and examination.

Then, depending on the case, you may propose (often in combination):

• Intralesional infiltrations (frequently with corticosteroids; sometimes combined with other drugs) in series to soften, flatten and reduce symptoms.

• Cryotherapy (freezing), especially in small lesions or as part of a combined plan; in more pigmented skin, the risk of color change is assessed.

• Laser as a support (for example, for color and relief), usually combined with other measures.

• Therapeutic pressure (garments or devices such as earlobe pressure earrings) for months, when indicated.

• Surgery is reserved for selected cases and almost always includes adjuvant therapy to reduce recurrence; superficial radiation therapy may be considered in specific contexts after careful risk-benefit analysis. American Academy of Dermatology Association 2023 Walsh 2023

The central idea (based on evidence and clinical practice) is that the best control usually comes from a multimodal approach and realistic expectations: improving relief, texture, and symptoms rather than completely “erasing” them. Ekstein 2021

Frequently Asked Questions

Does a keloid go away on its own?

• It is most common for it not to disappear completely without treatment. It may stabilize, but unlike many hypertrophic scars, keloids tend to persist. NHS 2023

Can I use silicone if I still have a scab?

• Generally, no. Silicone is used when the skin has already healed and there is no active wound. If you have any doubts about the appropriate time, it’s best to confirm with a professional. Juckett 2009

Does surgery «cure» it?

• It may be part of the treatment plan, but surgery alone has a high recurrence rate. Therefore, it is usually accompanied by adjuvant measures (for example, injections, pressure, cryotherapy, laser, and, in selected cases, radiotherapy). Gold 2014

Do injections hurt? How many are needed?

• They can be uncomfortable; they are usually performed in series . The number depends on the size, location, and response. Many clinics use strategies to improve tolerance (e.g., local cold therapy).

Is a keloid dangerous?

• It is generally not malignant. The impact is usually functional (rubbing, tightness, limitation) or on quality of life (symptoms and appearance). If a lesion changes rapidly, bleeds, or ulcerates, it should be evaluated. American Academy of Dermatology Association 2022

If I’ve already had a keloid, should I avoid piercings or tattoos?

• If you are prone to keloids, it’s generally wise to avoid further skin lesions. However, if you still consider it important, prior consultation and early monitoring are recommended.

What can I expect from the treatment?

• In realistic terms: partial reduction of raised areas and hardness, less itching/pain, and in some cases, improved color. Maintenance may be required; there is a risk of recurrence. Ekstein 2021

Bibliography and sources

American Academy of Dermatology Association 2023
American Academy of Dermatology Association 2023
American Academy of Dermatology Association 2022
NHS 2023
Royal Free London NHS Foundation Trust 2024
British Association of Dermatologists 2017
Mustoe 2002
Juckett 2009
Gold 2014
Ogawa 2017
Walsh 2023
Ekstein 2021