Keloid Scars
Not every scar fades quietly into the background. Some carry on growing long after the wound beneath them has healed, becoming raised, shiny and often much larger than whatever caused them in the first place. These are keloid scars, and in my experience they are one of the most misunderstood skin conditions patients bring into clinic.
I’ve had patients concerned over a scar from a piercing that happened fifteen years ago. There is nothing to apologise for. Keloids can be itchy, tender, and for many people, a genuine source of self-consciousness. Treating them properly is not vanity, it’s good medicine.
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What causes keloid scars
When your skin is injured, however minor, your body sends in collagen to repair the damage. In most of us, that process switches off once the wound has closed. In some people, it doesn’t. The collagen keeps being laid down well beyond the edges of the original injury, and the result is a scar that is thicker, harder and wider than it should be.
Keloids can follow almost anything: an ear piercing, an acne spot, a vaccination, a tattoo, even a small insect bite. I’ve seen keloids the size of a two pence piece grow from a wound no bigger than a pinprick. There is a strong genetic element too. Family history matters, and keloids are considerably more common in people with darker skin tones, particularly those of African, Afro-Caribbean and South Asian heritage. If your mother or father scars this way, it’s worth being cautious with elective piercings or procedures.
It’s worth distinguishing keloids from hypertrophic scars, which are often confused. Hypertrophic scars are also raised and red, but they stay within the boundary of the original wound and tend to settle over time. Keloids spread beyond it and rarely improve without treatment. Getting this distinction right matters, because it changes what I recommend.
What to look out for
Keloid scars can appear anywhere on the body, though the ears, chest, shoulders and jawline are particularly prone areas in my clinical experience. They’re typically:
- Raised above the surrounding skin, sometimes considerably
- Pink, red, purple or darker than the surrounding skin
- Itchy, and occasionally painful or tender to touch
- Firm or rubbery when you press on them
- Slow to appear, sometimes taking months to fully develop after the original injury
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Our consultations are in-depth and tailored to you, creating a bespoke treatment plan catering to all of your concerns.
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I will be honest with patients from the first consultation: a keloid scar cannot be entirely erased. Anyone who promises complete removal is overselling what medicine can deliver. What we can do, reliably and effectively, is flatten it, soften it, and calm the itching and discomfort that so often comes with it.
Our first-line treatment is corticosteroid injections directly into the scar tissue. The steroid works by reducing inflammation and slowing that overactive collagen production, which allows the scar to flatten and settle over subsequent weeks.
This isn’t a one-off treatment. I tell patients to expect a course of at least three sessions, spaced around six weeks apart, so the tissue has time to respond between injections. Some stubborn keloids need more. Patience matters here far more than it does with most cosmetic treatments, because you are working with the way this particular patient’s skin behaves, not against a fixed timeline.
For scars that don’t respond fully to injections alone, or that have been present for a long time, we can discuss combining this with other approaches as part of a bespoke plan. What I won’t do is recommend simply cutting a keloid out on its own. Surgical excision without proper follow-up treatment is one of the most common reasons keloids come back larger than before. If surgery is ever appropriate, it’s alongside, not instead of, medical management.
Why the consultation matters so much here
Keloid scars are one of those conditions where a proper, unhurried consultation changes the outcome. I need to know your skin type, your family history, where the scar sits, how long it’s been there and what’s already been tried. Two keloids that look identical on the surface can need completely different treatment plans.
If you’re dealing with a keloid scar, whether it’s new or something you’ve lived with for years, come and talk to us. We’ll give you an honest assessment of what’s achievable, and a realistic plan to get there.
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