Keloids & Hypertrophic Scars

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What Are Keloids and Hypertrophic Scars?

Keloids and hypertrophic scars are raised scars that develop when the skin produces excess collagen during the healing process after an injury. They may occur after acne, surgery, burns, cuts, piercings, vaccinations, or other skin trauma.

Although both are raised scars, they have important differences.

Keloids

Keloids are thick, firm scars that grow beyond the boundaries of the original wound. They may continue to enlarge over time and can recur after treatment.

* Raised, smooth, shiny scar
* Extends beyond the original injury
* Pink, red, brown, or darker than surrounding skin
* Itching, tenderness, or discomfort
* May continue to grow over months or years

Common Sites

* Earlobes
* Chest
* Shoulders
* Upper back
* Jawline and neck

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Hypertrophic Scars

Hypertrophic scars are raised scars that remain within the boundaries of the original wound. They usually appear within weeks after an injury and may gradually flatten over time.

Common Features

* Thick, raised scar
* Limited to the original wound
* Red or pink in the early stages
* May feel itchy or slightly painful
* Often improves gradually over months to years

Common Sites

* Surgical scars
* Burns
* Cuts and lacerations
* Areas of high skin tension such as joints

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Risk Factors

* Family history of keloids
* Darker skin tones
* Acne scars
* Burns or surgical wounds
* Ear or body piercings
* Repeated skin trauma
* Delayed wound healing

Symptoms

* Raised, thickened scar
* Firm or rubbery texture
* Itching or tenderness
* Pain or discomfort
* Cosmetic concerns
* Restricted movement if the scar is over a joint

When Should You See a Dermatologist?

Seek medical advice if:

* A scar continues to enlarge.
* The scar becomes painful, itchy, or bothersome.
* The scar limits movement.
* You develop a raised scar after surgery, burns, or acne.
* You are considering cosmetic scar improvement.

Prevention

* Practice proper wound care.
* Avoid unnecessary skin trauma or piercings if you are prone to keloids.
* Protect healing wounds from excessive tension.
* Follow your doctor’s instructions after surgery.
* Seek early evaluation if a scar begins to thicken.

Treatment

Treatment depends on the type, size, and location of the scar. A dermatologist may recommend one or more treatment options, including:

* Silicone gel or silicone sheets
* Corticosteroid injections
* Cryotherapy (freezing)
* Laser therapy
* Pressure therapy
* Surgical removal (in selected cases, often combined with other treatments to reduce recurrence)

Early treatment often provides the best cosmetic and functional results. If you notice a scar becoming thick, raised, or extending beyond the original wound, consult a dermatologist for timely evaluation.

What is the main difference between a keloid and a hypertrophic scar?

The primary difference lies in how far they spread. Hypertrophic scars remain strictly within the boundaries of the original skin injury and may naturally shrink over time. Keloids, however, grow aggressively beyond the borders of the initial wound, invading surrounding healthy skin, and rarely resolve without clinical treatment.

Can a keloid form from something as minor as a bug bite or ear piercing?

Yes. In individuals who are genetically predisposed, keloids can be triggered by incredibly minor skin injuries, including insect bites, ear or body piercings, acne blemishes, chickenpox marks, or even small scratches, long after the original wound has closed.

When should I consult a dermatologist for a raised scar?

You should see a professional if a scar becomes increasingly thick, painful, tender, or intensely itchy, or if it continues to expand weeks or months after the injury. Early clinical interventions—such as targeted corticosteroid injections or laser therapies—are far more effective when started before the scar hardens and grows too large.