Most scars flatten and fade over time. Keloids and other raised scars do not. They can stay thick, firm and noticeable for years, and keloids can grow well beyond the original wound. Many people also find them itchy or tender.
The good news is that raised scars can be treated, and newer keloids usually respond best. Here is what to know, and how we approach treatment at our Downtown Brooklyn office.
Key takeaways
- Hypertrophic scars are raised but stay within the original wound. Keloids grow beyond it.
- Keloids are more common in people with darker skin and in people with a family history of them.
- Common sites include the earlobes, chest, shoulders, upper back and jawline.
- Treatment usually combines several approaches, such as steroid injections, silicone and sometimes removal.
- Keloids can come back, so a long-term plan matters.
Keloids vs. hypertrophic scars
Both happen when the skin makes too much collagen while healing, but they behave differently.
- Hypertrophic scars stay within the borders of the original injury. They often appear within weeks of the wound and may slowly flatten on their own over a year or two.
- Keloids spread beyond the original wound, sometimes becoming much larger than the injury that caused them. They can appear months later, rarely go away on their own and can keep growing.
Both can be pink, red, brown or darker than the surrounding skin, and both can itch or feel tender. Our page on scars and keloids has more detail.
What causes keloids?
Keloids form after skin injury, even a minor one. Common triggers include:
- Ear piercings, especially cartilage and earlobe piercings
- Acne and folliculitis, particularly on the chest, back and jawline
- Surgical incisions
- Burns, cuts and grazes
- Vaccinations and insect bites
- Tattoos
Sometimes a keloid seems to appear without any injury you remember.
Who is at higher risk?
Keloids can happen to anyone, but they are more common in people with Black, Hispanic and Asian skin, in people with a family history of keloids, and in people between their teens and thirties. If you have had a keloid before, you are more likely to form another one after future injuries. That matters when planning piercings, tattoos or elective surgery. Our page on skin of color covers other conditions that affect darker skin differently.
How we treat keloids and raised scars
Keloids are best treated with a plan rather than a single procedure. Many patients use two or more of these options together.
Steroid injections
Steroid injections into the scar are one of the most common treatments. They soften and flatten the scar and reduce itching and tenderness. Most patients need a series of injections spaced several weeks apart.
Silicone sheets and gels
Silicone applied daily for several months can help flatten raised scars and may reduce the chance of new ones forming after surgery or injury.
Pressure
Pressure earrings or garments are often used after earlobe keloid removal to lower the risk of recurrence.
Surgical removal
Cutting out a keloid alone often leads to it coming back, sometimes larger. When removal makes sense, such as for a large earlobe keloid, it is usually combined with steroid injections, pressure or other steps afterward. We offer scar revision and earlobe repair.
Laser and other options
For some raised or red scars, lasers can help with color and texture as part of a larger plan. Your provider will talk you through whether this makes sense for your scar.
What to expect at your first visit
At your first appointment, your provider looks at the scar, asks how and when it formed, and asks whether it itches, hurts or is growing. It helps to bring photos if the scar has changed over time. We also ask about any past treatments and whether you have had other keloids.
From there, we talk through a realistic goal. For most keloids the aim is a flatter, softer, less itchy scar, not one that disappears completely. Many patients start steroid injections at the first visit and return every few weeks to track progress. If the keloid is on the earlobe and removal makes sense, we plan the procedure and the steps afterward that lower the chance of it coming back.
Preventing keloids
If you are prone to keloids, a few steps can lower your risk:
- Think carefully before new piercings or tattoos, especially on the ears, chest and shoulders
- Treat acne early to prevent inflamed breakouts on the chest, back and jaw
- Tell any surgeon you have a history of keloids before a procedure
- Start silicone or other preventive care soon after an injury or surgery, if your provider recommends it
- Get a new keloid looked at early, while it is smaller and more responsive to treatment
Frequently asked questions
Will my keloid go away on its own?
Keloids rarely go away without treatment. Hypertrophic scars sometimes flatten over time, but treatment can speed that up.
Do steroid injections hurt?
There is a pinch and some pressure. Many patients find the relief from itching and tenderness is worth it.
Can keloids come back after treatment?
Yes, which is why treatment is usually a combination of approaches followed by monitoring. Early treatment of any new growth helps.
Is keloid treatment covered by insurance?
Coverage depends on your plan and whether the keloid is causing symptoms like pain or itching. Our team can help you check your coverage. See our insurance page.
Can I get my ears pierced again after an earlobe keloid?
Many people can, but it carries a real risk of a new keloid. Talk with your provider before re-piercing.
Book a scar consultation in Downtown Brooklyn
Our Downtown Brooklyn office is at 100 Livingston Street, 3L, and our providers include board-certified dermatologists Dr. Mitchell Mandel and Dr. Emily Tongdee. Book online or call or text (347) 797-5005.