Keloid scars and hypertrophic scars

Some scars grow lumpy and larger than the wound they are healing. This is called keloid scarring. It can happen to anybody, but is more common in people with dark skin, such as people from African, African-Caribbean and south Indian communities.

The body's tissue naturally heals itself when it is damaged. This healing process can cause scars to appear. 

If the skin is broken (for example, by a cut, bite, scratch, burn, acne or piercing), the body produces more of a protein called collagen.  

What are keloid scars?

Hypertrophic scars

Hypertrophic scars are another type of raised scar that can also restrict movement.

 

Unlike keloid scars, they are within the size of the original wound.

 

Hypertrophic scars can last for several years.

Collagen gathers around the damage and builds up to help the wound seal over. The resulting scar usually fades over time, becoming smoother and less noticeable.

However, some scars don't stop growing. They "invade" the surrounding healthy skin and become bigger than the original wound. These are known as keloid scars.

Some scars become red and raised within the size of the original wound. These are called hypertrophic scars. Find out more about hypertrophic scars.

"A keloid scar is an overgrown scar that can spread outside the original area of skin damage," says Hermione Lawson of the British Skin Foundation. "Keloid scars are shiny and hairless, they're raised above the surrounding skin, and can feel hard and rubbery."

Keloids affect around 10-15% of all wounds. They can appear anywhere on the body, but usually form on the shoulders, head and neck.

They can last for years and sometimes don't form until months or years after the initial injury. New keloid scars are sometimes red or purple. They're not usually painful, but some people feel embarrassed or upset if they think the scar is disfiguring them.

Experts don't fully understand why keloid scarring happens, but these scars are not contagious (they're not catching) and there is no risk of them turning into cancer.

Who gets keloid scars?

Keloid scars can affect anyone, but some people are more likely than others to get them. "People with dark skin get keloids much more easily than people with fairer skin, and it's common in people with black skin," says Lawson. It's thought that keloid scarring may run in families.

Keloid scars can develop after even a very minor injury. "Burns, acne scars and wounds that get infected are particularly likely to form keloids," says Lawson.

"You're at higher risk of getting a keloid scar if you have had one before."

Can I reduce the risk?

You can't stop a keloid happening, but you can avoid any deliberate cuts or breaks in the skin, such as tattoos or piercings, including on the ear lobes.

What is the treatment for keloid scars?

There are several treatments available, but none have been shown to be more effective than others. Treatment can be difficult and isn't always successful. Treatments that may help flatten a keloid include:

  • steroid injections
  • applying steroid-impregnated tape to the area for 12 hours a day
  • applying silicone gel sheeting to the area for several months, although a review of studies found that it is unclear whether this works or not to prevent or treat keloid scars

Other options are:

  • freezing early keloids with liquid nitrogen to stop them from growing
  • laser treatment to lessen redness (this won't make the scar any smaller)
  • surgery to remove the keloid (however, the keloid can grow back and may be larger than before)

If you're bothered by a keloid scar and want help, see your GP.

Scars: skin camouflage

An expert explains how skin camouflage is used to cover marks and scars. Dina, who has hyperpigmentation, describes how it improved her confidence.

Media last reviewed: 22/11/2013

Next review due: 22/11/2015

Page last reviewed: 12/06/2014

Next review due: 11/06/2016

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Comments

The 21 comments posted are personal views. Any information they give has not been checked and may not be accurate.

PaulJWorcs said on 24 September 2014

I've had four Keloid scars, two were situated on joints, my knee and my elbow, after accidents when I was a child. They seemed to be caused by the broken layer of skin that occurred when falling over.
Later in my early twenties I had a keloid form from a cut on my left ear, this was treated with surgery and a pressure device that was moulded from the shape of my ear and then tightened onto my ear every night.
This was very effective, I went from having low confidence and staying in all the time to being normal and having no apparent scarring on my ear. I had regular trips to the Queen Elizabeth hospital in birmingham for re-fits of the moulded plastic pressure device.
I have one keloid at the moment which is on my right arm. I had been injected with steroid in this scar about three times but found it of little benefit, it reduced but always expanded again about two weeks later. Currently I'm using Haelan tape which has definitely reduced the swollen nature of the scar. Just waiting now to see whether or not the scar will expand when I stop using it, I've been applying the tape for one week and will continue to use it for the three months my GP recommended.

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Superdavebrown said on 31 July 2014

I have suffered with these scars for 20 years, on numerous occasions the GP has done minor surgery on them which knowing what I know now would never have agreed to as they just got worse each time. Then after this I had a few steroid injections and time flattened most of the scars. In recent years I had a scar appear on my shoulder must have been after a acne spot as no other damage to skin occurred and finally after years I thought I would visit the GP to get this sorted. He was a very nice GP and said he could inject it with steroids but he first wanted to try steroid tape and I agreed to try. I had previously read about the steroid tape and people mentioned that it took a very long time but I was surprised to find that after only having used it for 1.5 weeks that the scar has decreased by at least 2 thirds already. The tape is easy to apply and pain free so at present I can honestly say I am happy with this treatment. Hope this info helps you.... 1 tip tho dont let them cut it out!

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elastoplast said on 27 March 2014

I had an operation and was told I had dissolvable stitches.
When I went to the doctor four weeks later because the scar was raised and red and itched the doctor had to take the stitches out as they were not dissolvable and told me that it looked like a keloid. Asked if I had been told what to do after the op I explained I had been given no information, just sent home. She explained if I put Vaseline on it, it may smooth out and also take the redness away.....fingers crossed

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b4rbie said on 29 October 2013

I had Keliod scars and after trying numerous things, including, helian tape, liquid nitrogen, steroid injections my mum suggested I try Salactol Gel which is used for curing warts. I have to admit, my keliods have almost gone. They have flattened, and the redness is completely gone. The scar is also almost disappearing. It's an extremely corrosive method I admit but it has been the most effective. I had them in the middle of my chest area, directly in line of my chin on my chest and on my shoulder and some on the back. I have to say the Salactol has made a massive improvement.

Try it out, but be warned, this method hurts, but it's well worth it.

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DollyM said on 13 October 2013

The doctor quoted in this article saying that keloids are not usually painful has probably not had much experience in this area. My keloids have always been extremely painful with unbearable itching. I have suffered from many keloids to the ears since my teens due to peircings im now in my 40s. I have had many excisions after regrowth but successful removal only when accompanied with radiation therapy. This is obviously risky and can increase your chances of dev cancer but is the only thing that worked for me. In the past. I have one keloid that regrows from a helix peircing I had when 26. 2 Excisions and a pressure clip layer it's still here and is very painful. Trying home remidies such as t-tree asprin and so on but to no avail. I had steroid injections in the past but find them to be excruciatingly painful and inaffecive, on me anyway also my keloids got bigger. I'm hoping to find something that will at least shrink it or stop the growth I would be satisfied with that If not complete removal without further scarring.

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QueeniJenni said on 07 June 2013

I had my keloid scan on the center of my chest for more than 10 years now. I am Chinese not too fair not too dark skin. I had it when i was in high school. Started with a pimple then grow bigger. At first i have no idea what it is so i use necklace to cover it up which make the keloid grow even bigger. Anyway i went to my first treatment in Singapore. The doctor gave a treatment which include 1 steroid injection, 1 botox injection and 1 IPL light scan. The result after 3-4 treatments my keloid has flatten but not 100% but at least it is quite flat and redness are reduce. Before i moved to UK i should have went for another treatment but i did not. So when i'm in the UK my keloid start to grow back on the right side. Went to the doctor here they just injected my keloid with steroid . I did advise them how Singapore doctor did their treatment but they just said "we don't do that". So now my keloid is still lump and red. Definitely still growing. Applied many different cream not really working.

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Angie2013 said on 02 June 2013

From recent personal experience, i disagree that nothing can be done to prevent a keloid. For the first time last year, i developed a really itchy and ugly keloid on my upper arm after mole removal by my local dr. Prior to then, i had never had an issue with healing at all (even had a caesarian 1 yr before). After several months of itching and my baby picking at it, i went to a plastic surgeon to cut it out. 4 months on, i have had no recurrence of the keloid. The surgeon mentioned to me that if i had no prior history of keloiding, it was very likely a result of either poor surgical technique by my GP, or infection, or both. Instead of using removable stitches like my GP, he used dissolving sutures. Which meant no further trauma to the skin upon excision. I was also put on a course of antibiotics post excision. I also decided to use an anti inflammatory cream (Hirudoid) after 2 weeks of initial healing. At the same time as that excision, i also had a mole removed from my upper back and toe. Despite me not bothering to pay any attention to these areas post op, i have NOT developed any further keloids. I think keloid development is very much dependent on the dr and his/her surgical technique, sutures they use, whether youre given antibiotics straight after, and use of an anti inflammatory cream. I have MANY more moles i wish to cut out over the next few months. I am still a little afraid i will keloid again, and then have to fork out money to have them revised; however, this time i am going to a specialist surgeon to have them removed, one body region at a time, as i found dealing with scarring gone bad, so very exhausting. But i am PROOF that you can prevent them. (As an aside, i am a 36 yr old, white, quite healthy female, so i didnt fit the profile of a typical keloid sufferer).

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LarkB said on 08 May 2013

As others have stated, people with very fair skin also tend to develop keloids although they are usually flat and may spread across the skin instead of forming nodules. I have blonde hair, very pale skin and freckles and any injury, including surgical incision, results in keloid formation. Also because I grew up in the 50's and 60's when little was known about the dangerous effects of sun exposure, I have had several basal and squamous cell carcinoma lesions removed. The resulting keloid is often larger and more prominent than the original lesion. The keloid that resulted from small pox immunization as a child is about the size of a quarter.

This article should be edited to include that not only those with dark skin can develop keloids.

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c_man said on 18 January 2013

I have suffered from Keloid Scars for the last 10 or so years and its very disheartening to be informed there is no cure or prevention for this nasty and stubborn condition.

I recently tried a spray called Kelo-cote which is apparently designed to provide relief (have detailed experience at KeloidScarForum) however it was a disaster and a waste of money - the product itself being quite expensive. It initiated more growth on my existing keloids and proved to be a waste of time/effort/money.

I have also tried Haelan Tape and glad to report its actually quite useful. This was prescribed via the NHS as apparently its not available over the counter. Its a very thin tape with a small concentration of steriod (I think cortisone?) and I tend to place it over a spot or cut where I think there is a chance of keloid scar tissue forming.

If anyone has other topical applications they can recommend (would rather avoid injections) then please do reply!

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JanPan58 said on 21 June 2012

I had a long, ugly, keloid scar on my stomach following removal of my gall bladder. As I was only 19 I was referred (after a bit of badgering) to plastics, who injected it about 6 times along the length with steroids. It has since diminished greatly and is now barely noticeable.

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slg1012 said on 13 April 2012

I have a keloid scar on my chin. It's been treated approx 4 times with liquid nitrogen, which was initially quite successful, but the lump did come back each time. A year ago a Consultant Dermatologist carried out a biopsy on it, and it is now bigger than ever.

My GP has said he could remove it (which would involve a 1inch incision in my chin) and while I don't mind being left with a 'normal' scar I'm very anxious that the keloid would come back worse than ever. If it was anywhere other than my face I would let him remove it straight away.

Maybe having it cut away and then using silicon sheets on it would be the best option?

I can no longer bear to have photgraphs taken because the scar is so obvious and am extremely self concious in social situations.

If anyone else had the same problem on their face I'd really love to know the outcome if you had it surgically removed.

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themelissun said on 07 February 2012

I am 21 years old and I have a lot of scars on my left arm which have been there for no more than 5/6 years.
I'm really really concerned abou them, they look awful, they're laddered right up my arm to my shoulder, they were self-induced when I was younger when I found a very bad situation I was put in difficult to cope with.
One of them is very very large, about 1cm wide by 5cm long. I think it could perhaps be a keloid? I don't know.
Anyway, I'de like them to be removed somehow, I have used apparent scar-removing oils to no avail. The scars I am most concerned about are the scars around the large one, as if those smaller ones can be removed, I wouldn't mind too much having the one big scar as I can blame it on accidentally burning myself on an iron or something.
Will the NHS support my request for some way to remove these scars?

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ias said on 29 September 2011

I am reading all comments with much frustration for the following reasons:

1. Keloid scarring and Hypertrophic scarring look similar, but are totally diferent

2. Keloid scarring is discussed fully, but Hypertrophic scarring fails to be discussed or emphasised by NHS Choices - thus deepening ignorance and anxieties.

3. keloid scarring are stubborn deep and thick scars that are difficult for surgeons to treat. Almost always, a steroid such a Kenalog is used - injected into the scar to help reduce the scar

4. Almost likely that with treatment - even laser treatment, that Keloid scarring will return - even larger than original. It is an ongoing process of treatment

5. Hypertrophic scarring is not stubborn in the way keloids are. Hypertrophic scars can be smoothed by laser without the use of steroid. Such laser procedures of this scar are also successful with light and dark skin types too.

6. NHS Choices needs to provide a much more educated and useful information website that will ensure a better understanding of treatment - ON ALL SKIN TYPES.

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Susie said on 05 May 2010

Dear bilk, thank you for your comment. The source for the statement that there is not much evidence that applying silicon gel sheeting is effective in flattening keloid scars is a review of 15 trials. You can see the review in the Cochrane Library:

http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD003826/frame.html

From Susie at NHS Choices

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bilk said on 21 April 2010

How can you day that "applying a silicone sheet to the area at night for several months (however, there is not much evidence that this works)" I work in a burns unit and we use them all the time on the classic red raised scars and they do work, as for evidence there are at least 9 clinical trails that I am aware of 5 of which are randomised, the two I have in front of me are
Carney, SA. et al. CICA-CARE Gel sheeting in the management of hypertrophic scarring. Burns 1994; 20(20):163-167
Quinn, KJ. Silicone gel in scar treatment. Burns 1987; 13 (Supplement): S33-S40
While I agree that some of the once a day treatments and gels are not much use the one we use is proven to work in 90% of cases on scars upto 20 years old.
I myself used it on a scar I developed after surgery and it work very well, although it is still there the redness has gone and it is an awful lot flatter. I bought it from the local chemist by the way

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edinburgh said on 28 November 2009

I diagnosed myself as having a keloid scar after watching 'Embarrassing Bodies' on tv. Prior to this (3 or 4 years ago now) I had been referred to the hospital for the odd-looking lesion at the top of my leg. I had had it from about age 8 but it had begun to grow slightly in my 40s. The hospital didn't know what it was but took a biopsy to check it wasn't cancerous (it wasn't) and invited me back to be ogled at by lots of doctors who between them didn't know what it was either. Not sure why they'd never heard of keloid scarring. Unfortunately for me the biopsy had the effect of making the scar grow bigger - I reckon it is now at least twice the size it was before I had the biopsy! Thank goodness it is on a part of my body that rarely sees day light but must admit I rarely go swimming or sunbathe in public now because of how ugly it looks.

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s**e said on 11 June 2009

steroids made my keloid ten times worse

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s**e said on 11 June 2009

i am a 21 year old woman and developed my keliod scar at around the age of 7 from a cat scratch on my chest.
I have tried 3 types of scar reducing strips, creams, steroid injections and surgery to remove it but all failed!!
i had the surgery febuary 08 and now it is bigger than ever before!
I now get sharp stabbing pains in my keloid which at times can be unberable due to having the steroid injections every 2 months for around 16 months.
i have now run out of ideas and my doctors dont ether.

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User144133 said on 06 February 2009

I am fair skinned and freckled. As a result of my BCG immunisation at the age of 13 I have an upper arm scar that grows. It is now 1.5 inches long from being a pin prick. (Runs in the family - an aunt and both of my sisters have the same scars.)
The growth has stopped for a number of years since receiving steroid injections. I tried the gel pads with no success but after my sister was offered steroid injections in Saudi Arabia I asked for the same in the UK and got it. The scar is now my normal skin colour (rather than burning red) and it has flattened significantly. It has started to grow again (they missed a bit with the injections) and I am waiting for another referral to the dermatoogy consultant. My cesarean scar also started to grow on one side. The injections have flattened it and prevented any further growth 5 years on.
The injections were given though insulin needles which apparantly makes them more effective. Worth asking your GP as it was certainly not offered as an option when I first asked about it.
Used to get some pain in the scar as if nerves were being caught. Doesn't happen now.

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clareruth said on 12 January 2009

I am very fair skinned and blonde (my parents are both very fair skinned too) and 10 years ago I got a keloid scar after I had a mole removed on the back of my neck.

I had two steroid injections and the scar is now completely flat and a normal pale scar colour. It was quite an angry purple to start with but interestingly after a holiday in the sun (with sun protection of course!) the colour improved dramatically.

These injections were covered by the NHS (not sure if that would still apply now but worth asking).

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User63450 said on 13 November 2008

my dad is west indian and my mum is white. In 1970 i had an op on the back of my knee which resulted in a keloid scar. It is unsightly, but i choose to view it gratefully as it means that once again i can bend both knees when i walk.

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