A keloid is a raised, firm scar that grows beyond the edges of the original wound and does not go away on its own. Keloids can follow ear piercings, acne, surgery, vaccinations, burns, tattoos and even tiny scratches. They are more common in people with darker skin, including many people of African and Asian descent, and often run in families.
This guide explains why keloids form, how they differ from other raised scars, the treatments that work best, and practical steps to reduce the risk, especially before piercings or surgery.
Imagine a young man who had his ear pierced at 16. Within a year, a lump formed behind the earlobe. He had it cut off at a local clinic, and within months it came back, larger than before. He now hides it with his hair and avoids photos. A nurse in a dermatology clinic explains that keloids often return after surgery alone, and that combining surgery with other treatments, and following up closely, gives a much better chance. For the first time, he understands his scar.
Keloid vs hypertrophic scar
| Keloid | Hypertrophic scar | |
|---|---|---|
| Size | Grows beyond the original wound | Stays within the wound edges |
| Timing | Can appear months later and keep growing | Appears within weeks |
| Natural course | Rarely improves on its own | Often flattens over 1 to 2 years |
| Recurrence after removal | Common | Less common |
| Common sites | Earlobes, chest, shoulders, upper back, jaw | Anywhere, especially over joints |
Why keloids form
When skin heals, cells called fibroblasts produce collagen. In keloids, this process goes into overdrive: too much collagen is produced and it continues long after the wound has healed. Genetic factors, skin tension, inflammation and infection all play a part.
Who is at risk?
- People with darker skin tones.
- People with a family history of keloids.
- People aged roughly 10 to 30.
- Those with previous keloids.
- Pregnancy and puberty (hormonal changes may cause growth).
Symptoms
- Raised, shiny, firm or rubbery lump.
- Colour from skin-coloured to pink, red or darker brown.
- Itching, tenderness or pain.
- Gradual growth over months or years.
- Restricted movement if over a joint.
Treatments
| Treatment | How it helps |
|---|---|
| Corticosteroid injections | Flatten and soften keloids, reduce itching; usually repeated every few weeks |
| Silicone gel or sheets | Hydrate and flatten scars; used for months; good for prevention too |
| Pressure therapy | Pressure earrings after earlobe keloid removal |
| Cryotherapy | Freezing to shrink smaller keloids; may lighten darker skin |
| Surgical removal | Usually combined with injections, pressure or radiotherapy to reduce recurrence |
| Radiotherapy | Used after surgery in selected cases in specialist centres |
| Laser and other drugs (e.g. 5-fluorouracil) | Used by specialists for resistant keloids |
Important: cutting out a keloid alone has a high chance of recurrence, sometimes larger. Seek treatment from trained professionals with a follow-up plan.
Prevention
- If you are prone to keloids, avoid unnecessary skin injury: elective piercings (especially ear cartilage), tattoos and cosmetic procedures.
- Tell your surgeon or nurse before any operation that you form keloids, so they can plan wound closure and preventive care.
- Treat acne early to reduce scarring on chest and back.
- Care for wounds well: keep clean, avoid infection, minimise tension.
- Use silicone gel or sheets on new scars as advised.
- Watch new scars and seek early treatment if they start to rise or itch.
Living with keloids
Keloids are not cancerous or contagious, but they can affect confidence and comfort. Treatment can make a big difference, and early treatment works best. Read more about wound care in our wound dressings guide and about acne in our acne treatment guide.
Frequently asked questions
Can keloids go away on their own?
Rarely. Most need treatment to flatten or shrink.
Do keloids come back after surgery?
Often, if surgery is used alone. Combining it with other treatments reduces recurrence.
Are keloids dangerous?
No, they are benign, but they can be itchy, painful and distressing.
Should I get my ears pierced if I form keloids?
It is best to avoid piercings if you have had keloids before or have a strong family history.
But is it just cosmetic?
Not always. Keloids can itch, hurt, restrict movement and seriously affect self-esteem. They deserve proper assessment and treatment, not dismissal.
Your next step: If you have a scar that is growing, itching or spreading beyond the original wound, ask a nurse or healthcare provider for referral to a skin specialist before considering removal.
Related: Acne treatment · Wound dressings guide · Vitiligo
Sources: British Association of Dermatologists patient information on keloids; American Academy of Dermatology; published international clinical recommendations on scar management.
Leave a Reply