A keloid is a firm, raised overgrowth of scar tissue that spreads beyond the edges of the original wound and does not shrink on its own. Keloids can follow surgery, piercings, acne, vaccinations or even minor scratches, and they are more common in people with darker skin and a family history. They are benign, but they can be itchy, painful and distressing. Treatment usually combines steroid injections, silicone and sometimes surgery, and recurrence is a real possibility.
What makes a keloid different
In a keloid, the normal ‘stop’ signals that end the healing process fail, and the skin continues to produce thick bands of collagen for months or years. The scar spreads onto healthy skin, often forming a smooth, shiny, rubbery lump with claw-like extensions. Keloids may be pink, red, purple or darker than the surrounding skin. They can appear weeks, months or occasionally years after the original injury, and some seem to arise with no obvious trigger at all.
Who is most at risk?
- Genetics: a family history of keloids is one of the strongest risk factors.
- Skin tone: keloids are considerably more common in people of African, Caribbean, South Asian and East Asian heritage.
- Age: they most often develop between puberty and the thirties, although they can occur at any age.
- Hormonal changes: keloids may appear or enlarge during puberty and pregnancy.
- Previous keloids: having one keloid makes further keloids after new injuries more likely.
Where keloids commonly form
Keloids favour certain parts of the body: the earlobes (often after piercing), the upper chest and breastbone area, the shoulders and upper back, the jawline, and the upper arms. These are areas where the skin is under tension or movement. Keloids are less common on the eyelids, palms and soles. A keloid after a nose or ear piercing is a frequent reason for consultation, and is covered in our guide to a keloid on a nose piercing.
Symptoms and when to see a doctor
Besides their appearance, keloids can be itchy, tender or painful, and those across joints may restrict movement. Clothing can rub against chest and shoulder keloids. See your GP if a lump in a scar is growing, painful or bleeding. Although keloids are benign, any scar that ulcerates, bleeds repeatedly or changes character unexpectedly should be examined, and a biopsy is occasionally needed to confirm the diagnosis. Contact a doctor the same day if a keloid becomes hot, swollen and red with a fever, which may indicate infection.
Treatment options
Keloids are treated in stages, and a combination is usually more effective than any single approach:
- Steroid injections: the mainstay of treatment, given every few weeks to flatten and soften the keloid and relieve itch.
- Silicone gel or sheets: used daily for months, often alongside injections.
- Pressure: especially effective for earlobe keloids using specially made pressure earrings after excision.
- Surgical excision: removing the bulk of a keloid, always combined with injections or other treatment afterwards, because surgery alone often leads to recurrence.
- Specialist therapies: cryotherapy, other anti-scarring injections and post-operative radiotherapy are used for resistant keloids in specialist centres.
Why keloids come back
Keloids are notorious for recurring, sometimes larger than the original, because surgery itself creates a new wound that can trigger the same abnormal healing. This is why surgery is only one part of the plan, followed by months of injections, silicone or pressure and regular review. Setting realistic goals, such as flattening the keloid and easing symptoms rather than removing all trace of it, avoids disappointment. For a broader overview of scar behaviour, see our guide to types of scars.
Prevention if you are keloid-prone
If you know you form keloids, avoid elective piercings and tattoos, and tell any surgeon or doctor before a procedure, as incisions can be planned and aftercare adjusted. Treat acne early to reduce inflammation, and start silicone as soon as any new wound has closed. Early treatment of a keloid that is just starting tends to be more effective than treating a large, long-standing one.
Specialist assessment
Mr Nassab will examine the keloid, ask about your personal and family history, and recommend a plan appropriate to its size and location. Surgical scar revision is from £950; other keloid treatments are quoted at consultation, and the £150 consultation fee is separate. Cosmetic treatment is for adults aged 18 and over.
Frequently Asked Questions
Are keloids dangerous?
No, keloids are benign. They can, however, be itchy, painful and affect confidence, and any rapidly changing scar should be checked.
Can keloids be removed permanently?
Keloids can be reduced and controlled, but they can return after treatment, so ongoing follow-up is important.
Do keloids go away on their own?
Rarely. Unlike hypertrophic scars, keloids usually persist or slowly enlarge without treatment.
Are earlobe keloids easier to treat?
Earlobe keloids often respond well to excision followed by injections and pressure earrings, although recurrence is still possible.
