Private keloid & raised scars clinic in London, same-day dermatology.

Keloid or hypertrophic?

• Hypertrophic scar — raised, red and firm but stays within the original wound edges. Often improves on its own over one to two years.
• Keloid — grows beyond the original wound, often with claw-like extensions, and does not regress. May be itchy, tender or painful.
• Keloids favour the chest, shoulders, upper back, earlobes and jawline, and rarely occur on the eyelids, palms or soles.
• They can appear months after the injury, and sometimes after something trivial — acne, a vaccination, an insect bite, a piercing.

Who is at higher risk

• people with darker skin — the risk is many times higher in Black, African, Caribbean and East Asian skin
• a personal or family history of keloids
• age between about 10 and 30
• wounds under tension, or across the chest and shoulders
• wounds that became infected or healed slowly
• pregnancy, and some inflammatory skin conditions

Preventing them

• Tell your surgeon or practitioner beforehand if you or your family form keloids. It changes technique, closure and aftercare.
• Silicone gel or sheeting, started once the wound has healed and used for 12 to 23 hours a day for at least two to three months, is the best-evidenced preventive measure there is.
• Pressure earrings after ear piercing or earlobe keloid surgery.
• Avoid tension on the scar — support with tape, and avoid stretching movements early.
• Sun protection for at least a year; UV darkens and thickens new scars.
• Think carefully before piercing, tattooing or elective cosmetic surgery if you are keloid-prone, particularly on the chest, shoulders or ears.

Treatment

• Intralesional steroid injection is first-line, repeated every four to six weeks for several sessions. It flattens and softens most keloids and relieves itch and pain. Skin lightening and thinning at the site are recognised effects.
• Silicone and pressure continued alongside.
• Cryotherapy, sometimes combined with injection, for smaller lesions.
• Laser treatment for redness and to improve texture.
• Surgery with adjuvant therapy for large or pedunculated keloids, particularly earlobes.
• Expect improvement rather than disappearance, and a course of treatment over months rather than a single visit.