Why keloid scars grow and how to soften them
The difference between keloid and hypertrophic scars, their causes, steroid injections, silicone and preventing recurrence.
AuthorDr. Aygun MustafayevaAesthetic dermatologist, dermatovenereologist and trichologist
In some people even a small cut, an ear piercing or a spot ends up as a thick, raised, itchy scar. If such a scar grows beyond the borders of the original wound, it is called a keloid. If it stays within them, it is a hypertrophic scar.
Why it grows
According to current understanding, a keloid is the result of long-lasting inflammation in the deep layer of the skin: the wound heals, but collagen production does not stop. Tension in the skin strengthens this inflammation. That is why keloids most often form on the chest, shoulders, upper back and earlobes. Heredity and darker skin also increase the risk.
Treatment methods
- Corticosteroid injections into the scar: one of the main methods in international recommendations, reducing thickness, firmness and itching
- Silicone gel or sheets: for both preventing a new scar and treatment
- A combination of methods in severe cases
- Surgical removal only together with other methods: when only cut out, a keloid often returns, and larger
How the injections are done
Treatment follows an individual assessment and is done in stages, usually several sessions a few weeks apart. I choose the dose according to the size of the scar, because too much can thin and lighten the surrounding skin and make small vessels visible.
If you are prone to keloids
- Talk to a doctor first about ear piercing, tattoos and cosmetic incisions
- Apply silicone to a new scar from the early stage
- Treat chest and back acne without delay
- Come as soon as a scar starts to thicken: a fresh keloid responds better
Scientific sources
The information in this article is based on the peer-reviewed papers, systematic reviews and clinical guidance below.
- Ogawa, R. (2017). Keloid and Hypertrophic Scars Are the Result of Chronic Inflammation in the Reticular Dermis. International Journal of Molecular Sciences, 18(3), 606. [PMID: 28287424] | [DOI: 10.3390/ijms18030606]
- Gold, M. H., McGuire, M., Mustoe, T. A., et al. (2014). Updated international clinical recommendations on scar management: part 2: algorithms for scar prevention and treatment. Dermatologic Surgery, 40(8), 825-831. [PMID: 25068544] | [DOI: 10.1111/dsu.0000000000000050]
- Mustoe, T. A., Cooter, R. D., Gold, M. H., et al. (2002). International clinical recommendations on scar management. Plastic and Reconstructive Surgery, 110(2), 560-571. [PMID: 12142678] | [DOI: 10.1097/00006534-200208000-00031]
