Keloids

A keloid starts as a firm bump at a wound or piercing site and slowly spreads outward over months. The growth past the original edge is the giveaway.

What it looks and feels like

Where it shows up

• Earlobes, usually after piercing. The most common site by far.
• Chest, shoulders and upper back — high-tension skin, and where they get largest.
• Jawline and neck, often after acne or shaving bumps.
• Anywhere a wound, surgery, burn, vaccination or tattoo happened. Keloids almost never form on the eyelids, palms or soles.

How it looks on different skin tones

Keloids are far more common in Black, Hispanic and Asian skin, and that is genetics, not anything anyone did. On brown and Black skin they usually look dark brown, purple or nearly black rather than pink or red, which means the redness clinicians often describe may not be there at all. Treatments that lighten skin, especially freezing, leave more obvious pale marks on darker skin — that matters when choosing what to do.

Some raised scars are not keloids at all. See Lookalikes near the bottom of this page.

A keloid is a wound-healing response that does not switch off. When skin is injured, cells called fibroblasts lay down collagen to patch the gap, then normally slow down once the repair is done. In a keloid they keep going, producing far more collagen than the wound needed and spreading into the healthy skin nearby.

Why that happens comes down largely to genetics. Keloids run in families, and they are several times more common in people with Black, Hispanic and Asian ancestry. If a parent or sibling keloids, your odds are higher. Most start between the ages of 10 and 30, and they are less likely to start for the first time in older adults. Skin under tension — the chest, shoulders and upper back — is the most likely place. Pregnancy and puberty can make existing ones grow.

None of this is caused by poor wound care, and it is not a sign of anything wrong with your health. It is how your particular skin repairs itself.

Nothing over the counter flattens an established keloid. The two most heavily advertised scar products are here so you know what the evidence actually says before you spend on them.

There is no over-the-counter product that flattens an established keloid, so a visit is the practical next step for anything beyond a fresh wound you are covering with silicone.

• The scar is growing past the edge of the original wound.
• It itches, stings or hurts.
• It is pulling on a joint, ear or the neck and limiting movement.
• You are planning surgery, a piercing or a tattoo and you already have keloids.
• A raised scar is changing shape, bleeding or ulcerating — that needs a look to rule out something else.
• It is affecting how you feel about being seen, which is a fair reason on its own.

What the visit gets you: steroid injections into the scar, which is the main treatment and is not something you can do at home; a combination plan if surgery is being considered, because cutting a keloid out alone has a high failure rate; and a plan to protect any future wounds.

Topical prescriptions play a supporting role in keloids rather than a leading one. They are usually added alongside injections rather than used alone.

This is where keloid treatment actually happens. The recurring theme: nothing here is used alone if you want it to last, and surgery in particular has to be paired with something else.

Keloids are not dangerous, and they do not turn into cancer. The problems they cause are mostly physical and practical.

Not every raised scar is a keloid, and the difference changes what happens next.

• Hypertrophic scar — the important one. Raised, firm and sometimes itchy like a keloid, but it stays inside the original wound edges and usually flattens on its own over one to two years. It responds better to treatment and rarely comes back. If your scar has not crossed the line of the wound, this is probably what you have.
• Dermatofibrosarcoma protuberans — a rare, slow-growing skin cancer that can look like a firm keloid, especially on the trunk. Suspect it when a firm lump grows steadily with no injury there in the first place. A biopsy settles it.
• Acne keloidalis nuchae — firm bumps and bands at the back of the neck and hairline, mostly in Black men, starting from inflamed hair follicles rather than one wound. Treated differently, and shaving practices matter.
• Dermatofibroma — a small, hard, brownish nodule that dimples inward when you pinch it. Usually on the legs, and it does not grow outward the way a keloid does.
• Hidradenitis suppurativa scars — thick ropy scarring in the armpits, groin or under the breasts, with a history of recurring painful lumps and tunnels rather than a single injury.
• Foreign body reaction — a firm lump around a splinter, suture or piercing material left behind. It settles once the material is out.