Understanding Keloids: Why Some Scars Keep Growing
Most scars gradually become flatter and less noticeable. Keloids are different — they can become raised, firm and extend beyond the original wound. Here's why that happens and what can be done about them.
What Is a Keloid?
A keloid is a type of raised scar that develops when the skin produces too much scar tissue while healing. Unlike a typical scar, a keloid can continue growing beyond the boundaries of the original injury.
Keloids may develop after relatively minor injuries such as acne, cuts, burns, surgical incisions, vaccinations or ear piercings. They can occur anywhere on the body, although the chest, shoulders, upper back, jawline and ears are common locations.
Why Do Keloids Keep Growing?
During normal wound healing, the body produces collagen to repair damaged skin. Once the wound has healed, collagen production gradually slows down.
With a keloid, this healing process can become overactive. Fibroblasts and other cells involved in wound repair may continue producing excessive amounts of collagen and extracellular matrix. This can result in thick, raised scar tissue that continues to enlarge.
Genetic tendency
Some people are naturally more prone to developing keloids because of differences in their wound-healing response.
Excess collagen
An overactive repair process can cause collagen to accumulate instead of gradually settling down.
Skin injury
Surgery, piercings, burns, acne and other forms of skin injury can trigger keloid formation in susceptible people.
What Can Trigger a Keloid?
Keloid vs Hypertrophic Scar
Keloids are often confused with hypertrophic scars because both can appear raised. One important difference is how they behave relative to the original wound.
| Feature | Keloid | Hypertrophic Scar |
|---|---|---|
| Raised | Yes | Yes |
| Extends beyond original wound | Often | Usually no |
| May continue growing | Yes | Usually settles over time |
| Recurrence after treatment | Can occur | Generally less persistent |
What Does a Keloid Look and Feel Like?
Keloids can vary in size, shape and colour depending on the person and location.
How Are Keloids Treated?
Keloid treatment is different from treating an ordinary scar. The goal may be to flatten the scar, reduce symptoms, improve its appearance and prevent further growth or recurrence.
Corticosteroid injections
Steroid injections may help soften and flatten some keloids and reduce symptoms such as itching or discomfort.
Silicone therapy
Silicone sheets or gels may be recommended as part of scar management, particularly for prevention or early scar care.
Pressure therapy
Pressure-based approaches may be useful for certain keloids, especially in areas where appropriate pressure can be maintained.
Surgical removal
Surgery may be considered for selected keloids, but removal alone can have a significant recurrence risk, so additional treatment may be needed.
Can Keloids Be Prevented?
If you have developed a keloid before, it is worth telling your dermatologist or surgeon before undergoing another procedure. People with a history of keloids may need a specific scar-prevention plan.
- Avoid unnecessary skin trauma or piercings if you are highly prone to keloids.
- Follow wound-care instructions carefully after surgery or injury.
- Discuss scar-prevention options early if you have a history of keloids.
- Do not repeatedly irritate or pick at a healing wound.
- Seek professional advice if a scar becomes increasingly raised, firm, itchy or starts extending beyond the original wound.
When Should You See a Dermatologist?
Consider getting a professional assessment if:
A scar continues to grow after the wound has healed.
The area becomes persistently itchy, painful or tender.
The scar begins extending beyond the original injury.
You are concerned about an increasingly raised or unusual scar.
Frequently Asked Questions
Are keloids dangerous?
Keloids are generally benign scars and are not cancerous. However, they can cause itching, tenderness, restricted movement in some locations and cosmetic concerns.
Can a keloid disappear on its own?
Keloids generally do not disappear completely on their own. Some may stop growing, while others can remain stable or continue enlarging.
Can keloids come back after treatment?
Yes. Keloids can recur after treatment, particularly when they are surgically removed without additional recurrence-prevention measures. This is why treatment is often planned as a combination approach.
Can acne cause keloids?
Acne can trigger abnormal raised scarring in people who are prone to keloid formation, particularly on areas such as the chest, shoulders and upper back.
Is every raised scar a keloid?
No. Hypertrophic scars, acne scars and other types of raised or thickened scars can look similar. A dermatologist can examine the scar and determine the most appropriate diagnosis and treatment.
The Bottom Line
Keloids develop when the body's wound-healing process produces excessive scar tissue. Unlike ordinary scars, they can become raised and extend beyond the original injury.
The good news is that keloids can often be managed with appropriate treatment. Because they have a tendency to recur, early assessment and a treatment plan tailored to the individual scar are important.
Concerned About a Growing Scar?
If a scar is becoming raised, firm, itchy or larger than the original wound, a dermatology consultation can help determine whether it is a keloid and what treatment options may be appropriate.
Book a ConsultationThis article is for general educational purposes and should not replace an individual medical consultation. Treatment suitability varies from person to person and should be determined by a qualified medical professional.
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