Keloid scars: what to know

Keloids can develop after an operation, piercing, burn, acne spot, injection, or minor skin injury. They may feel firm, itchy, tender, or tight and can continue enlarging beyond the wound edges. Their colour may differ from nearby skin. A raised scar that stays within the original wound is more consistent with a hypertrophic scar, but appearance alone is not always enough for diagnosis. A clinician should examine any new or changing lump and consider other causes of skin lumps.

Keloids are not contagious. They are not caused by poor hygiene, and cutting one out alone can allow it to return. The treatment plan depends on size, location, symptoms, skin type, previous treatment, and whether movement is restricted.

Do not pierce, pick, or repeatedly irritate an area that has formed a keloid. Arrange assessment before choosing a cosmetic procedure or elective piercing. Options may include steroid injection into the skin, pressure or silicone-based care, pulsed dye laser treatment for redness, fractional laser treatment for texture, cryotherapy, or a combined plan. Keloid removal surgery may be considered for selected scars, usually with additional treatment to reduce regrowth.

Keep follow-up appointments because a scar can change after treatment. Tell the clinician about previous keloids, acne near the area, pregnancy, medicines, and any history of poor wound healing. Treatment may improve itch, firmness, colour, or height without making the skin identical to unscarred skin.

Seek prompt review if a scar grows quickly, becomes ulcerated, bleeds without clear injury, develops drainage, or becomes hot and increasingly painful. Arrange assessment if a lump is changing or restricting movement. Fever, spreading redness, or pus after a procedure may indicate infection and needs timely medical care.

Ask whether the lesion is a keloid or another scar type, what caused it, which outcome the proposed treatment targets, how many follow-up visits may be needed, and how recurrence would be managed. Ask whether treating nearby acne or avoiding further trauma could prevent additional scars.