Keloid – how is it different from a scar and how to treat it?

Content author: MD. Piotr Rak, surgeon · Editorial work: Editorial team of Wyspa Medycyny Przyjaznej · Medical review: lek. Piotr Rak · Date of creation: 07.08.2026 · Date of review: 07.08.2026 · Updated: 07.08.2026

The article is of an educational nature and does not replace a medical consultation or qualification for treatment, which requires examination. A scar that begins to ulcerate, bleed, grows rapidly, changes color, or does not heal despite treatment requires urgent medical evaluation - not every thickening at the site of a former wound is a keloid scar.

The most important information at a glance

• Keloid is excessive scarring in which tissue extends beyond the original wound and infiltrates healthy skin.
• A hypertrophic scar is thickened but remains within the wound and usually flattens on its own over time. Keloid doesn't do this.
• Keloid does not go away on its own and will not "smooth out over time". Without treatment, it usually persists or gets worse.
• Common symptoms include itching, burning, tenderness and a feeling of tightness - keloids are not only an aesthetic problem.
• Typical locations are the sternum and neckline, shoulders, nape of the neck, pierced ears and the jaw area.
• Risk factors include family predisposition, darker skin, young age, tension in the wound and chronic inflammation, e.g. in acne.
• Surgical excision alone without adjuvant treatment is associated with a high risk of recurrence - often greater than the initial lesion.
• The basis of conservative treatment are intralesional injections, pressure therapy, silicone dressings and cryotherapy - usually in combination.
• Treatment is a process spread over months, requiring a series of treatments and checks, and not a one-time procedure.
• Prevention remains the most effective: in people prone to keloids, each planned procedure requires prior discussion of the risks.

Find out more about the specialist

Doctor. Piotr Rak is a surgeon at the Island of Friendly Medicine in Gdańsk. He deals with surgical procedures, including removal of skin lesions and correction of scars. In the case of keloid scars, the correct classification is particularly important: distinguishing keloid from hypertrophic scar and selecting a procedure that will not lead to a recurrence greater than the initial lesion.

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How does scar tissue form and what goes wrong with keloid?

Wound healing occurs in three phases: inflammatory, proliferative and remodeling. In the proliferative phase, fibroblasts produce collagen that fills the defect. During the remodeling phase - lasting many months - excess collagen is removed and the fibers are arranged parallel to the skin surface. The scar gradually fades, flattens and softens.

In keloid this mechanism fails at a specific point: the stop signal is missing. Fibroblasts remain active after wound closure, collagen production remains high and its degradation processes are weakened. Collagen is deposited in thick, disordered strands, and the process spreads to adjacent healthy skin.

This is where the feature that defines keloid and distinguishes it from all other scars comes from: exceeds the limits of the original damage. A small prick can cause a lesion many times larger than the wound that started it.

This also explains the most important therapeutic problem. If the injury itself triggers an overreaction, keloid removal is another injury — and without action to stop this process, it usually leads to a recurrence.

Keloid and hypertrophic scar - key differences

These two changes are sometimes confused, also in offices. However, the distinction has real consequences: the prognosis and management are completely different.

The simplest differentiating question is: is the thickening within the outline of the old wound or has it gone beyond it? The answer is not a substitute for research, but it is this feature that is most decisive in practice.

It is worth adding that the thickening in the place of the scar is not always a keloid or a hypertrophic scar. Diagnoses that require separate treatment include, among others, granulomas around a foreign body, cysts, inflammatory lesions, and rarely also skin cancer developing within an old scar. A lesion that ulcerates, bleeds, or grows rapidly requires medical evaluation.

Who is at risk and where do keloids occur most often?

The tendency to develop keloid scars is largely an individual feature over which we have no influence. Factors that increase the risk include:

• the presence of keloids in parents or siblings,
• darker skin,
• younger age - keloids are more common in teenagers and young adults,
• previous keloid in another location,
• wounds healing with complications, infection or granulation,
• chronic skin inflammation, for example severe acne,
• tissue tension in the wound and mobility of the area,
• piercing of ears and other body parts,
• pregnancy and periods of hormonal changes.

Location is as important as predisposition. Keloids most often form where the skin is constantly stretched by movement or breathing: on the sternum and cleavage, shoulders, neck, back and jaw area. A separate, very common group are keloids on the auricle after piercing - in predisposed people, they can grow to a size many times larger than the puncture site.

Keloids rarely appear on the eyelids, palms and soles of the feet. This is no coincidence: these areas differ in the structure of the skin and the way tension is distributed in them.

Why is cutting itself the most common mistake?

This question is asked in almost every consultation: "if it's a growth, why not just cut it out?" The answer results directly from the mechanism of keloid formation.

Keloid is formed in response to skin damage in a person whose repair response is excessive. Surgical excision is a new lesion - and larger than the original lesion, because the incision must cover the entire lesion. In a patient with a preserved predisposition, the same reaction is triggered again, and the recurrent keloid tends to be larger than the one removed.

Therefore, the modern approach is based on two principles. First, treatment usually begins with conservative methods, not with a scalpel. Second, if the procedure is warranted, it is performed always in combination with adjuvant treatment — injections, pressure therapy or other methods that inhibit excessive scarring during the healing period.

Removing keloid on your own, without a plan of action for the following months, is a procedure that most often worsens the patient's situation.

Keloid treatment methods

Treatment is selected individually, depending on the size of the lesion, location, duration, symptoms, previous treatment attempts and the patient's tendency to relapse. In practice, methods are combined with each other because the combination gives better results than a single action.

The specific preparation, dosage, number of sessions and intervals between them are determined by the doctor during qualification, after assessing the change and contraindications. In some cases, referral to a center offering methods with a narrower scope of application is justified.

A realistic expectation is that the goal of treatment is to flatten the lesion, relieve itching and pain, improve appearance, and prevent further growth. It is not the complete disappearance of the scar - a scar remains in place of the keloid, but it looks better and is less painful.

Prevention - the most effective tool we have

There is an inconvenient truth when it comes to treating keloids: prevention is easier than cure. In a person who has already had keloid, each subsequent skin lesion carries the risk of another one. Therefore, prevention begins long before the procedure.

• Tell your doctor if you are prone to keloids before each planned procedure - including minor and aesthetic ones. This changes the planning of the incision, the way of suturing and the recommendations after the procedure.
• Give up unnecessary piercings ears and other areas if you have had keloid before.
• Don't delay acne treatment, especially inflammation on the back and chest - this is a common starting point for keloids.
• Protect the healing wound from tension: avoid stretching the area, use plasters or dressings as directed.
• Use silicone dressings prophylacticallyif your doctor recommends them, and do it consistently for the recommended time.
• Protect the scar from the sun for the first months - a fresh scar discolors easily.
• Do not scratch or irritate the healing area; chronic irritation promotes excessive scarring.
• Report earlywhen the scar begins to harden, itch and grow. Early intervention is more effective than treating a long-term lesion.

The last point is the most important in practice. Patients often report years later when the keloid is large and fixed. Meanwhile, the moment the scar begins to lift and itch is the best time to start treatment.

What not to do on your own

• do not try to cut, cut or "remove" the keloid yourself,
• do not use acids, burnishing preparations and home remedies described on the Internet,
• do not puncture the lesion or try to "squeeze" it,
• do not use strong ointments steroids without a recommendation - they have their own side effects,
• do not re-pierce the ear where keloid has formed without talking to your doctor,
• do not stop compression or silicone therapy after a few weeks, when these methods take months,
• do not delay consultation when the lesion grows, bleeds or becomes ulcerated.

Most common myths

• "Keloid is just a big scar." No. It is defined by the transcendence of the original wound, not its sheer size.
• "It will smooth itself out over time." No. Unlike hypertrophic scar, keloid does not go away on its own.
• "Just cut it out." No. Resection alone without adjuvant treatment carries a high risk of recurrence.
• "It's just an aesthetic problem." No. Keloids are often itchy, burning and tender, and in large lesions they may limit mobility.
• "Keloid can turn into cancer." No. This is a benign lesion - but a lesion that is ulcerating or growing rapidly requires evaluation because it may not be keloid.
• "The pharmacy ointment will solve it." No. Topical preparations may be part of treatment, but they are rarely enough on their own.
• "Once it's grown on me, I can't have any treatments." No. You can, but it requires a prior discussion of the risks and a prevention plan.
• "The treatment takes several weeks." No. It is a process spread over months, requiring a series of treatments and checks.

Is the scar thickened, itchy or is it growing beyond the wound?

The earlier treatment begins, the greater the chance for a good effect. During the consultation, we will assess whether it is a keloid or hypertrophic scar and plan the treatment.

Scar treatment in the Island of Friendly Medicine in Gdańsk

In the Island of Friendly Medicine doctor. Piotr Rak consults patients with scarring. The visit includes examination, distinguishing keloid from hypertrophic scar and other lesions, assessment of risk factors for recurrence and planning of treatment over time.

Part of a reliable qualification is a clear presentation of the perspective: keloid treatment is a process, not a one-time procedure, and requires the patient's cooperation for many months. Part of the qualification may also include advising against excision when the risk of recurrence exceeds the expected benefit. The current scope of treatments, availability of dates and prices should be confirmed during registration.

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What to ask the doctor during the consultation?

• Is my lesion a keloid or a hypertrophic scar?
• Does the change require additional diagnostics?
• Which method should I start with in my case?
• How many treatments does the treatment plan include and at what intervals?
• What effects are really possible and what are not?
• What side effects are associated with the proposed treatment?
• Does surgical excision make sense in my situation?
• What additional treatment will be necessary after the procedure?
• How high is the risk of recurrence and what reduces it?
• How long should I use silicone dressings or pressure?
• How to protect a scar from the sun?
• What should I report to my doctor before my next scheduled procedure?

FAQ - Keloid

What is keloid?

This is a form of excessive scarring in which scar tissue extends beyond the boundaries of the original wound and infiltrates the surrounding healthy skin. It occurs as a result of excessive collagen production and weakened mechanisms of its degradation.

How does it differ from hypertrophic scar?

A hypertrophic scar is thickened but remains within the wound and usually gradually flattens out. Keloid extends beyond the wound boundaries and does not go away on its own. This distinction determines the prognosis and treatment method.

Can keloid disappear on its own?

No. Unlike a hypertrophic scar, a keloid usually persists or increases in size. Waiting does not improve the situation, and treating more recent lesions is more effective than treating long-term lesions.

Is keloid dangerous?

This is a benign lesion that does not develop into cancer. However, it may cause itching, burning and tenderness, and in large cases limit the mobility of the area. A lesion that is ulcerating or growing rapidly requires medical evaluation.

Why can't you just cut it out?

Because excision is another skin injury that triggers the same excessive reaction in a predisposed person. Without adjuvant treatment, the risk of recurrence is high, and the new lesion may be larger than the removed one.

How are keloids treated?

Most often, combined methods: intralesional injections, silicone dressings, compression therapy, cryotherapy, and in selected cases laser therapy. Surgical excision is only used together with adjuvant therapy.

How long does the treatment take?

This is a process spread over months, including a series of treatments and follow-up visits. Methods such as silicone dressings or pressure require consistent use for a long time, which is a condition for their effectiveness.

Will the scar disappear completely?

No. The aim of treatment is to flatten the lesion, alleviate symptoms and improve appearance, and stop further growth. A scar remains in place of the keloid, but it is less visible and less bothersome.

Who is most at risk?

People with a family history of keloids, darker complexion, younger age, as well as patients with chronic skin inflammation, for example with severe acne. The risk increases in areas exposed to skin tension.

Where do keloids most often form?

On the bridge and neckline, shoulders, neck, back, around the jaw and on the auricles after piercing. They rarely occur on the eyelids, palms and soles of the feet.

Can I pierce my ear if I already had keloid?

This requires prior discussion with your doctor. Re-piercing the area where the keloid formed is associated with a high risk of recurrence and should be preceded by a prevention plan.

Who consults scars at WMP?

On the WMP website, doctor Piotr Rak is described as a surgeon who performs surgical procedures, including removal of skin lesions and correction of scars. The scope and availability of treatments are confirmed by registration.

Sources

• DermNet, Keloid and hypertrophic scar: https://dermnetnz.org/topics/keloid-and-hypertrophic-scar
• DermNet, Scar treatment: https://dermnetnz.org/topics/scar-treatment
• NHS, Keloid scars: https://www.nhs.uk/conditions/keloid-scars/
• NHS, Scars: https://www.nhs.uk/conditions/scars/
• NHS, Acne: https://www.nhs.uk/conditions/acne/
• British Association of Dermatologists, information for patients: https://www.bad.org.uk/patient-information-leaflets/
• British Association of Plastic, Reconstructive and Aesthetic Surgeons, information for patients: https://www.bapras.org.uk/public/patient-information
• NHS, Cosmetic procedures - what to consider before treatment: https://www.nhs.uk/conditions/cosmetic-procedures/