Keloid Scars: Causes and Treatments

Medically Reviewed by Zilpah Sheikh, MD on December 23, 2023
9 min read

Keloid scars are thick, irregular-looking scars that look larger than the original wound. They usually have a shiny, raised appearance and can cause minor discomfort. They range from flesh color to red or purple and can develop a variety of textures. 

Keloid scars are usually harmless, but some people find them distressing. In rare cases, they can be itchy, painful, or uncomfortable. Once keloids start to form, they can continue to grow for years, causing the scar to increase. Some keloids can grow as large as a grapefruit.

Keloids can appear anywhere on the body. You will mostly find them on the upper chest, head (especially the earlobes after piercings), shoulders, and neck. They're rarely seen anywhere on the face but may appear on the jawline. They're generally not dangerous, but some people may be concerned about their appearance.

Keloid scars vs. hypertrophic scars

Keloid and hypertrophic scars are somewhat similar. They are both caused by extra collagen production during the healing process. But, unlike a keloid scar that grows outside the injury site, a hypertrophic scar forms within the original wound. Other differences include:

  • Hypertrophic scars develop a couple of months after an injury, while keloids can develop months or years after.
  • Hypertrophic scars are easier to treat.
  • Hypertrophic scars are pink to red; keloids are red to purple.
  • Hypertrophic scars can go away on their own, while keloids will never go away without treatment.

Experts don't exactly know what causes a keloid scar to form instead of a typical scar. 

Collagen, a protein that helps repair skin injuries, usually helps scars develop normally. However, during healing, your body sometimes produces too much collagen, resulting in a keloid scar. Doctors are unsure why some people's bodies produce too much collagen after an injury.

Keloid scar piercings

Keloids may occur after getting piercings. Ear keloids might appear on the earlobes and the surrounding skin and cartilage after ear piercings. Keloid scars from piercings may itch or feel uncomfortable, but they usually don't hurt. They may also become irritated if rubbed or touched. 

Keloid scars from piercings may make you more self-aware about that body part. They may also trigger you to feel insecure, stressed, anxious, or depressed. 

Get your piercings from a professional or reputable piercer, ask them how to care for the piercing area, and follow their recommendations to reduce the likelihood of getting keloids after piercings. 

Keloid scar tattoos

Although they don't happen as often as keloid scars from piercings, keloids may also appear months to years after getting a tattoo. You might see an overgrown scar tissue on the tattoo spot or areas around it. Like keloids from other causes, the scar might feel tender or itchy.

You're more likely to get keloids after getting a tattoo if the tattoo covers a large part of the body, if you're prone to having keloids, or if the tattoo wasn't safely and correctly done. You can reduce your chances of getting keloid scars on your tattoo by using a professional tattoo artist and caring for your tattoo following their recommendations. Start with a small tattoo if you're concerned that a keloid could form. 

Keloid acne scars

Because acne scars are injuries on the skin, keloids may also form. You might find the keloid on or around the acne spot, usually larger than the acne. 

Leaving your acne untreated for a long time may increase your risk of scarring, which can develop into a keloid scar. You're also more likely to get keloids if you pick or squeeze your acne. 

You can treat acne with over-the-counter products containing active ingredients like adapalene, alpha-hydroxy acids, benzoyl peroxide, glycolic acid, or salicylic acid. You can also care for your skin by washing it with a mild cleanser twice daily, wearing sunscreen and sun-protective clothing, and not touching or picking your skin. 

See a doctor or dermatologist if these at-home remedies don't work in preventing or treating your acne. 

You might feel some itching or discomfort as a keloid forms, but most keloid scar symptoms are based on your skin's appearance.

What do keloid scars look like?

Keloid scars are usually larger than the original wound, thick or lumpy, and rise above the rest of the skin. They can also be identified by:

  • ‌A shiny appearance
  • Lack of hair on the scar
  • A hard and rubbery feel to the scar
  • Red or purple coloring in the beginning, which then changes to brown or pale coloring
  • A dome-like or irregular shape

When a surgical cut or an injury causes a keloid formation, the keloid scar tissue may keep growing for a while after the wound has been closed until it reaches its final size. ‌Sometimes, keloid scar tissue doesn't show up right after your injury. It may appear months or years later, and the scarring can last years.

You have a greater risk of developing keloid scars if you:

  • Have a family history of keloids. Some experts believe there may be a genetic component in why some people tend to get them more than others.
  • ‌Have had a keloid in the past
  • Have a wound that takes longer to heal
  • ‌Have darkly pigmented skin. People of African, Asian, and Hispanic origin form keloid scars 15 times more frequently than people with lighter skin, though it's unknown why this is so.
  • Are between the ages of 10 and 30
  • ‌Have done mesh skin grafts, which is a type of surgery used to transfer a part of healthy skin from one part of the body to another
  • ‌Are going through puberty or pregnancy, because the elevated hormones during these times may affect the wound healing process

Treatment options for keloid scar removal depend on several factors, including its size, location, and whether the scar is causing pain or causing you difficulty moving. The treatment may also depend on how old you are and how old the scar is. Typically, treatments may include:

Topical silicone gels and sheets

Topical silicone treatments to prevent keloids or stop them from growing are available over the counter. Experts theorize that silicone bonds with skin molecules and creates higher surface tension, encouraging the body to reduce collagen production in the area. These products may also help to repair broken blood vessels, reducing redness in scars.

Dermatologists recommend using silicone-based products for scars for at least 12 hours per day. Silicone gels and sheets work best on small keloids or as a preventative measure on fresh scars.

Keloid scar cream

A prescription-strength corticosteroid cream can help ease itchiness from your keloid. Avoid scratching or picking at your keloid to prevent further damage.  


An injection of a corticosteroid can reduce the size of a keloid scar. In general, steroids reduce inflammation and redness. However, they are helpful for keloids because they break up the connections between collagen molecules.

You can receive a steroid injection on an already existing scar. If you are getting surgery and are prone to keloid scars, your doctor may give you a steroid injection before or during the surgery to prevent keloids from forming again.

Experts recommend a series of five steroid shots given 4 to 6 weeks apart to reduce the size and improve the appearance of your keloid scar.

Radiation therapy

Some keloid scars can be treated with a low-dose radiation therapy known as superficial external beam therapy. 

This beam uses highly directed X-rays on the scar. It only penetrates the topmost layers of skin. It destroys the cells in your skin that produce collagen and causes fewer new scars to form. This treatment causes no pain and only takes about 10 minutes. Superficial external beam therapy is only recommended if over-the-counter gels or steroid injections do not work.

If you have a keloid scar removed surgically, your doctor may also recommend this treatment to prevent the scar from growing back.

Laser treatment

Pulsed-dye laser therapy can ease itchiness and help keloids to fade. You receive the treatment over several sessions with 4 to 8 weeks between sessions. This laser therapy is sometimes combined with cortisone injections. Side effects from this treatment are more common in people with darker skin, and they include blistering, crusting, and a change in skin color (hypopigmentation or hyperpigmentation).


Smaller keloids can sometimes be frozen off using liquid nitrogen. This treatment, called cryotherapy, can cause side effects including blisters, pain, and a loss of color in the affected skin (hypopigmentation).

Keloid surgery

If nothing else works, your doctor may recommend surgery to remove your keloid scar. However, up to 100% of keloid scars come back after surgery. Your doctor will likely recommend another treatment to go along with the surgery, such as steroid injections, to reduce the risk of further scarring.

Following your doctor's instructions after surgery will reduce the risk of the scar returning. Your doctor may tell you to wear a pressure garment for up to 20 hours per day for at least a few months to reduce the risk of a new scar forming.

Other treatments for keloid scars include: 

  • Steroid-impregnated tape, applied on your keloid for 12 hours a day
  • Pressure earrings, which are a special type of earring that helps to reduce the keloid scars in your earlobes   
  • Interferon injections to help reduce the size of keloid scars.‌ Interferon is a protein produced by the body to help fight viruses. 
  • Fluorouracil and bleomycin injections, which are anti-cancer agents that can be used to treat keloid scars.

Keloid removal may range from a few hundred dollars up to $3,500, depending on how big the scar is, where the scar is, and how complex the procedure is. This cost may also include any additional treatment after the keloid removal procedure, such as steroids.

Some insurance providers may cover keloid removal costs, especially if you confirm that it's medically necessary rather than to improve the look of the scar. 

The only surefire way to prevent a keloid scar from developing is to avoid injuries. If you know you are prone to getting keloids, you may want to avoid intentional injuries such as piercings, tattoos, or injections.

If you do get an injury, take care of it properly:

  • Keep your wound clean by washing it regularly with soap and water
  • Cover the wound with Vaseline or Aquaphor to keep it moist
  • Use a silicone gel pad or pressure pad to reduce the risk of developing a keloid scar
  • Follow your doctor's instructions for wound care after any surgery or procedure

Use these methods for 6 months after an injury if you're an adult, and for 18 months for a child.

You can take care of your skin on a daily basis to help improve the look and comfort of your keloid scars, plus prevent future keloid scars. Try the following:

  • Follow wound care instructions. After an injury or surgery, take the steps recommended by your doctor to help prevent keloids from forming. 
  • Stop the itch. You can get certain corticosteroid creams and silicone gels without a prescription. Apply them regularly to help ease itchiness around your keloid scar.
  • Use sun protection. The sun could actually affect the color of your keloid. Cover the keloid when you go outside, or apply sunscreen to your skin to protect it. 

How to flatten keloid scars naturally

Some evidence suggests taking onion extract by mouth or rubbing it on the keloid scar may make keloid scars look better and manage itching and tenderness. But you can't flatten keloid scars naturally or by yourself.


Keloids are generally harmless, but you should talk to your doctor if the scar feels painful, feels tender, is itchy or gets infected. Also, talk to a doctor if:

  • ‌You see a mole, a freckle, or a growth near the keloid scar.
  • ‌Your keloid scar is causing discomfort or making it difficult for you to move.

‌If you're concerned about how the keloid scar looks, talk to your doctor about skin treatments that can help make it less visible.‌

Keloid scars can be annoying and sometimes distressing, but are typically harmless. Work with your dermatologist  to find the treatment option that works best for you to reduce the size of your keloid scar or get rid of it entirely. Early treatment can reduce how much the keloid grows, so if you're bothered by keloids, talk to your doctor once you notice that one is forming.