Patient information · Dermatology
Keloid and raised scars
prevention beats treatment, by a distance
A keloid is scar tissue that grows beyond the boundary of the original wound and does not settle. They are considerably more common in people with darker skin, they are difficult to remove permanently, and the most effective approach is preventing them from forming in the first place.
Seek assessment if a scar
- is growing rapidly, ulcerating or bleeding
- is increasingly painful, or the skin over it is breaking down
- shows signs of infection — heat, spreading redness, pus, fever
- is restricting movement of a joint or the neck
- has changed in colour or texture after being stable for years
A long-standing scar that changes, ulcerates or will not heal should be examined and sometimes biopsied — skin cancers can very occasionally arise in old scars and burns.
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
Do not simply cut a keloid out
Excision alone has a recurrence rate reported as high as 50 to 100%, and the keloid that returns is frequently larger than the one removed. Surgery has a role, but only combined with adjuvant treatment — steroid injection, pressure, silicone, or in selected cases radiotherapy — and started immediately afterwards. If anyone offers to remove a keloid with no plan for what happens next, ask what the recurrence rate is.
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.
Itch and discomfort are treatable
Keloids are often described as purely cosmetic, but many are genuinely itchy or painful and some restrict movement. Antihistamines, topical treatment and steroid injection all help, and that is a legitimate reason to treat regardless of appearance. So is the effect on confidence.
Why come to us. Keloid treatment needs a course, not a consultation. Our dermatology and minor surgery teams assess the scar, give intralesional steroid injections in clinic, provide silicone and pressure treatment, and plan surgery with adjuvant therapy where it is genuinely appropriate rather than removing and hoping. If you are keloid-prone and considering any procedure with us — mole removal, cyst removal, circumcision, aesthetics — tell us first and we will plan the closure and aftercare around it.
Injections in clinic, and a plan across months
Dermatology and minor surgery on site, published fees. Seven days a week.
Tower Bridge Hospital London
97–99 Whitechapel Road, London E1 1DT
WhatsApp 07903 284 189
info@mhwclinic.co.uk
Open Mon–Sat, 9am–7pm (closed Sundays until September)
In an emergency
Call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
When we are closed and it is not an emergency
Call NHS 111 or visit 111.nhs.uk.