Keloids

Key Takeaways

Keloids are raised scars that grow beyond the borders of the original wound. Unlike a normal scar, a keloid keeps growing after the skin has healed and usually does not flatten on its own.

Keloids are much more common in skin of color. They are seen more often in Black, Hispanic, and Asian patients, and they often run in families.

Common triggers include ear piercings, acne, surgery, burns, tattoos, and other skin injuries. Sometimes even a small injury can lead to a large scar in someone who is prone to keloids.

Keloids can itch, hurt, feel tight, and cause cosmetic distress. They are not dangerous or contagious, but they can have a major effect on confidence and quality of life.

There is treatment, but there is no one-size-fits-all cure. Keloids are difficult to treat and often come back, which is why dermatologists usually use a combination approach rather than surgery alone.

If you have a scar that is growing past the original wound or becoming painful, itchy, or bulky, it is worth seeing a dermatologist early.

What Is a Keloid?

A keloid is a firm, raised scar that forms when the skin’s healing process goes into overdrive. After an injury—such as a piercing, acne breakout, surgery, burn, or cut—the body makes collagen to repair the skin. In most people, that process slows down once the wound closes. In someone who is prone to keloids, it does not slow down the way it should. The scar keeps building and may continue to enlarge for months or even years.

Keloids are different from normal scars in two important ways:

1. They grow beyond the original injury.

2. They usually do not regress on their own.

Keloids are not cancer, not contagious, and not caused by poor wound care or poor hygiene.

Fast Facts

• What is a keloid?

  A raised scar caused by an overactive healing response

• Who gets it?

  Anyone can, but keloids are much more common in people with darker skin tones

• Where do they show up?

  Commonly on the earlobes, chest, shoulders, upper back, jawline, and sometimes the lower abdomen

• What triggers them?

  Ear piercings, acne, surgery, burns, tattoos, vaccinations, and other skin injuries

• Can they go away on their own?

  Usually no

• Can they be treated?

  Yes, but recurrence is common, so treatment often needs to be ocmbined and repeated

Keloids are estimated to affect roughly 4.5–16% of people with darker skin, compared with a much smaller percentage of people with lighter skin. They also often appear between ages 10 and 30, when skin injury, acne, piercings, and hormonal changes are common.

What Do Keloids Look Like?

Keloids usually appear as firm, smooth, rubbery nodules or plaques that rise above the skin. They may start as a small bump and gradually become thicker, broader, and more noticeable over time.

Common features include:

• a raised scar that grows beyond the original wound

• a smooth or shiny surface

• itching, which is one of the most common symptoms

• pain, tenderness, burning, or tightness

• continued growth over weeks to months after the skin has healed

Keloids and hypertrophic scarring are two types of scarring that get confused all the time, but they are not the same. This difference matters because keloids are generally harder to treat and more likely to recur.

Hypertrophic Scar

• stay within the original wound borders

• may improve or flatten with time

• are still raised, but usually behave less aggressively

Keloid

• grow beyond the borders of the original wound

• can continue enlarging over time

• do not usually flatten on their own

• are more strongly associated with skin of color and family history                  

Understanding How Keloids Develop

Keloids happen when the body produces too much scar tissue during wound healing. Instead of stopping
when the skin has repaired itself, the scar-building process keeps going.

You do not need to know the full molecular biology to understand the big picture. The main reasons keloids happen are:

• genetic susceptibility — they often run in families

• an overactive healing response

• skin injury or inflammation, even from acne or piercings

• possibly hormonal and immune factors that make some people more prone than others

So while the trigger may be a piercing or surgery, the deeper issue is that the skin was already prone to forming a keloid.
Other common triggers include:

• ear piercings

• acne lesions

• surgical incisions

• burns

• tattoos

• vaccinations

• insect bites

• cuts, scratches, or any trauma that prolongs healing

Ear piercings are one of the most common triggers in skin of color, but acne-related keloids on the jawline, chest, and back are also very important—especially for people who have a history of severe acne or acne scarring.

Why Keloids Can Be so Frustrating

1. They can cause real symptoms - Itching, pain, tenderness, burning, tightness, and restrict movement if it sits over a joint

2. They often come back- Recurrence is one of the hardest parts of keloid treatment. A keloid may improve with therapy and then slowly return months later. That is why dermatologists often recommend combination treatment and ongoing follow-up rather than assuming one procedure will “fix” it permanently.

Skin of Color Perspective

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Skin of Color Perspective |

Why do keloids matter in Skin of Color?

Keloids are one of the clearest examples of a skin condition that disproportionately affects people with skin of color. They are especially common in people of African, Asian, and Hispanic descent, and many patients have a family history of similar scars.                                        

 For OSOH readers, the skin-of-color angle matters for a few reasons: 

• The risk is higher 

• The color can look different on deeper skin tones 

• Common triggers such as ear piercings and acne may carry a bigger long-term scar burden 

• Treatment decisions have to balance scar control with the risk of pigment change 

  In other words, keloids are not just “a scar problem.” They are a scar problem that often intersects with cultural practices, visible skin changes, and long-term recurrence.

In skin of color, keloids may look:

• dark brown 

• reddish-brown 

• purple 

• hyperpigmented compared with surrounding skin 

• occasionally lighter than the surrounding skin 

That color variation matters because early keloids do not always look like the pink-red scars often shown in textbooks.

Treatment Options

• Silicone gel or silicone sheets

  These are often used early or after procedures to soften the scar and reduce symptoms. They are not a miracle treatment, but they are low risk and often part of a long-term scar plan.

• Steroid injections

  Intralesional corticosteroid injections are one of the most common first-line treatments. They can help flatten the scar, decrease itching, and reduce inflammation.

• Steroid + 5-fluorouracil (5-FU)

  This is a common combination approach for more stubborn keloids. It can work better than steroid alone in some cases and may improve flattening.

• Cryotherapy or laser in selected cases

  These may help in some patients, especially as part of combination therapy, but they need to be used carefully in deeper skin tones because of the risk of post-inflammatory hyperpigmentation or hypopigmentation.

• Surgery with adjunct treatment

  IteIf a keloid is very large or bothersome, surgical removal may still be part of the plan—but usually not by itself. It is often combined with steroid injections, silicone therapy, radiation in selected cases, or other treatments to reduce recurrence.

Skin of Color Treatment Pearls

1. Treat early if a scar is clearly becoming a keloid

   A small, itchy, enlarging scar is often easier to manage than a large, established keloid.

2. Surgery alone usually has a high recurrence risk

   If someone offers to simply “cut it out,” it is reasonable to ask what the recurrence-prevention plan is afterward.

3. Acne control can be keloid prevention

   For patients who form keloids on the jawline, chest, shoulders, or back, controlling acne early can help reduce future scar burden.

4. Procedures can affect pigment

   Injections, cryotherapy, and lasers may help, but in deeper skin tones they can also cause light or dark marks if used too aggressively.

5. Think ahead before elective piercings or tattoos

   If you have a personal or family history of keloids, it is worth having a serious conversation with yourself—and sometimes with a dermatologist—before getting another piercing, tattoo, or elective skin procedure.

   
   Building a Simple Routine

What you can do at home

Home care will not erase a true keloid, but it can still help support treatment and reduce irritation.

Helpful habits:

• use silicone gel or silicone sheets if your dermatologist recommends them

• avoid picking, scratching, or rubbing the scar

• protect exposed scars from the sun to reduce pigment change

• treat acne early if you are prone to acne-related keloids

• tell surgeons, piercers, or other clinicians if you have a history of keloids before any elective skin procedure

Mistakes to Avoid

• DIY “scar burning” or harsh home remedies

• assuming the scar will flatten on its own if it is clearly expanding

• repeatedly traumatizing the area with friction or scratching

When Should You See a Dermatologist?

Consider seeing a dermatologist if:

• a scar is growing beyond the original wound

• the scar is itchy, painful, tight, or tender

• you have a family history of keloids and a new scar is becoming raised

• you are developing keloids after acne, piercings, or surgery

• you are considering surgical removal and want to understand recurrence prevention

• the scar is affecting your confidence, clothing choices, or daily comfort

If you have skin of color and know you are prone to keloids, it is especially helpful to get advice early, before the scar becomes larger and harder to control.

FAQ

• Are keloids permanent?

  They can persist for years and usually do not disappear on their own, but they can often be improved with treatment.

• Can I just have a keloid cut out?

  Sometimes surgery is part of treatment, but surgery alone has a high recurrence risk. Most dermatologists pair excision with other therapies.

• Do keloids mean I did something wrong with wound care?

  No. Keloids are not caused by poor hygiene or bad wound care. They are a problem of overactive healing in susceptible skin.

• Can acne cause keloids?

  Yes. In some people, acne—especially on the chest, shoulders, jawline, or back—can trigger keloid scars.

• Should I get another piercing if I already formed a keloid?

  That is usually worth thinking very carefully about. If you have a personal or family history of keloids, another piercing may carry a real risk of forming another one.

References

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Medical Disclaimer

This article is intended for educational purposes only and should not replace professional medical advice. Always consult a qualified healthcare professional regarding diagnosis or treatment of a medical condition.