Larger than the wound
The scar extends beyond the former wound or puncture and continues to grow.
CONDITION / SKIN AND SCARS
Keloid scar.
A keloid scar is a dense scar that continues to grow and extends beyond the boundaries of the original wound: on the chest, shoulders, ears, neck, or anywhere on the body. It is benign, but without treatment it usually does not flatten, and after excision it tends to recur, so treatment combines several methods.
CONCEPTUAL VISUALIZATION- What it is
- A scar that continues to grow and extends beyond the boundaries of the original wound.
- Where it happens
- Anywhere on the body; more often on the chest, shoulders, chin, neck, shins, and ears.
- Who is at risk
- Those who have already had keloids or have them in the family; the typical age of onset is 10–30 years.
- The main thing
- Treatment involves a combination of methods and long-term monitoring because keloids tend to recur.
01 / WHAT IS ITWhat is
What is
keloid scar.
A keloid is a benign overgrowth of scar tissue. Most ordinary scars lighten over time, while a keloid continues to grow: its red edge, which itches, gradually extends onto healthy skin beyond the original wound.
It appears several weeks, and sometimes years, after the skin is damaged, grows for months or years, and usually does not flatten or fade without treatment. If a keloid is on or near a joint, moving can be uncomfortable or difficult.
It can be confused with a hypertrophic scar. That is also thick and firm, but it stays within the wound boundaries and mostly becomes flatter over the years. Treatment depends on this, so a doctor distinguishes between them.
Keloids can itch, be painful, and noticeably affect well-being: in three reviews of 30 studies, the quality of life of people with keloids was significantly worse than that of people without them.
This is general information. The doctor will tell you what will suit you after the examination.
02 / SIGNSHow to recognize
How to recognize
keloid scar.
The signs are the same on any part of the body. Whether it is really a keloid can ultimately only be determined by a doctor.
Hard and shiny
Usually smooth and shiny; color — flesh-colored, pink, red, purple, brown, or darker than the surrounding skin.
Itching and pain
Especially while the scar is growing; when growth stops, this usually goes away.
Near a joint
A keloid on or near a joint can interfere with movement.
On the ear
Ears are one of the common places for keloids, especially after piercing.
Keloid of the auricleOn the face
The chin and neck are also among common locations; treatment on the face has its own specifics.
Keloid scars on the face03 / REASONSWhy does it appear?
Why does it appear?
keloid scar.
A keloid grows where the skin is damaged, but not in everyone. Why some people are prone to keloids and others are not is not fully understood, and no genetic test can yet predict the risk.
Any skin injury
A cut, burn, surgery, acne, or piercing — a keloid can appear even after minor trauma.
Heredity
In a study of 715 patients in China, keloids in people with a family history were more severe and more often appeared on multiple areas of the body; among first-degree relatives, 7.62% had keloids — more than in the control group.
Age and pregnancy
Keloids typically appear between the ages of 10–30; the risk is higher during pregnancy, as well as if keloids were already present.
Skin color
Keloids are more common in people with darker skin — of African, South Asian, Chinese, or Afro-Caribbean descent. In light-skinned people, they are rarer and usually not as pronounced.
Tension and pressure
Factors contributing to keloid growth include tension of the wound or scar, high blood pressure, hereditary traits, and lifestyle.
Burns
After a burn, both keloids and scars that tighten the skin and restrict movement can form.
Post-burn contracture
04 / SEEK MEDICAL ADVICE
When to seek medical advice?
A keloid is a planned situation: it usually does not require urgent care. But a scar or fresh wound can become infected, and the infection can spread. Call 103 if there is even one of these signs:
103 immediately if:
- the bleeding cannot be stopped;
- bright red blood beats in a stream;
- very high temperature, fever or severe chills;
- the heart beats very often or breathing is rapid;
- purple spots appeared on the skin;
- the person is confused or disoriented;
- skin is cold, sticky, or pale;
- The person does not respond to appeals or faints.
Do not delay a visit to the doctor:
On the same day: the keloid or other scar is swollen, sore, hot to the touch, or pus is released from it; the skin around is sore, hot and swollen. Planned: The scar grows, itches, hurts, interferes with movement, or just bothers you - make an appointment for a consultation. Start treatment early - this can help the keloid not grow further.
05 / DIAGNOSTICSAs a doctor
As a doctor
makes a diagnosis.
- History of the scar
What was the reason, how much time has passed, is the scar still growing, have there been keloids before or in relatives who have already tried.
- Review
The doctor compares the scar with the edges of the former wound, evaluates its density and color, asks about itching and pain, and checks whether it interferes with movement.
- All areas
Other scars are also examined: there may be several keloids, and the plan depends on their number and size.
- Distinguish from a tumor
Some benign and malignant tumors resemble a keloid; if the formation is unusual, the doctor will order an examination.
06 / TREATMENTHow we treat
How we treat
keloid scar.
The goal of treatment is to make the keloid flatter and softer, relieve itching and pain, and prevent it from returning. International guidelines recommend combining methods and tailoring them to each person. A small solitary keloid can be removed with additional treatment or treated non-surgically with several methods; large or multiple keloids are reduced in size and number through surgery.
01
Without surgery
This is often where they start.
- Silicone
- Gels or adhesive sheets are considered the first choice. In a Cochrane review (20 studies, 873 people), silicone reduced thickness and improved the color of scars, but the quality of these studies is low.
- Hormone injections
- The drug is injected directly into the scar as a course — either alone or after excision. According to a review of 21 studies, after excision with such injections, keloids returned in 6.6–33% of cases depending on the regimen.
- Cryotherapy
- The scar is frozen, including from the inside. In a review of 8 studies, the average reduction in keloid volume ranged from 51 to 63%, pain and itching mostly decreased, but on average the scar did not completely disappear. In people with dark skin, persistent light spots were a problem.
- Laser
- It is used together with other methods. A Cochrane review (15 studies, 604 participants) concluded that there is currently insufficient evidence to confirm or refute the effectiveness of laser treatment for keloid and hypertrophic scars.
02
Surgery
Only together with other treatment.
- Why not excision alone
- Without additional treatment, a removed keloid tends to grow again and can become larger than it was.
- Combination of methods
- A review of 21 studies (over 8,627 patients) concluded that combining excision with additional treatment significantly reduces recurrence compared to surgery alone, and drug combinations consistently produced better results than a single drug.
- Compression
- After excision, the area is constantly pressed with a special dressing or device; in two studies from the same review, recurrence was 10.66% and 14%; the authors note that compression is especially effective for ear keloids.
- Radiation therapy
- It is performed after excision. In a review of 72 studies (9,048 keloids), recurrence after surgery with radiation was 22%, and after radiation alone — 37%; the most common side effect was skin color change. In a meta-analysis of 106 studies (10,745 keloids), different types of radiation resulted in 14–18% recurrence and 9–18% complications. It is prescribed and carried out by a radiotherapist.
- Keloids on the chest
- In a review of 72 studies, chest keloids recurred more often than on other areas.
03
Prevention and monitoring
- Before the operation
- If you have already had keloids, tell your surgeon in advance. For people at high risk, a Cochrane review found weak evidence that silicone on a newly healed scar reduces the risk of thickening.
- Piercings and tattoos
- People prone to keloids are advised to avoid them, and acne should be treated promptly to reduce the risk of scarring.
- Long observation
- No matter what the treatment was, it is advised to be monitored by the doctor for a long time.
- Your assessment is important
- Patients and doctors do not always evaluate a scar in the same way, and combined treatment usually received better evaluations from the patients themselves. Tell your doctor what concerns you personally.
07 / AT THE VALIKHNOVSKYI INSTITUTE
How
How
we treat it.
Keloid scars at the Valikhnovskyi Surgery Institute are treated by dermatologists and surgeons in the 'Rehabilitation after Aesthetic Surgery' department, while keloids after burns are treated together with the 'Reconstruction after Burns' department. The clinic is responsible for excision, injections, laser treatment, and scar care; if radiation therapy is needed, it is performed by a radiotherapist at a specialized facility.
CLINIC SERVICE
Rehabilitation after aesthetic surgery
Laser and IPL for scars, lymphatic drainage, physiotherapy, and dermatologist supervision after plastic surgeries.
View service
What we do for this condition
- Dermatologist examination — scar assessment, selection of treatment and care.
- Silicone and compression garments — initially conservatively: gel, plates, or tape, and for large scars — compression.
- Injections into the scar — as a standalone treatment or after excision.
- Fractional CO2 laser and IPL — laser — for surface, stiffness, and itching of the scar, IPL — for redness and pigmentation.
- Excision with combined treatment — surgery is considered when the scar does not respond to conservative treatment or limits movement; excision is combined with other methods.
- Wound closure — if there is insufficient skin after excision — Z-plasty, local flaps, or skin graft.
- Follow-up check-ups — to notice in time if the scar starts to thicken or darken, and to change the treatment.
Rostislav Valikhnovskyi
Plastic surgeon, candidate of medical sciences, founder of Dr. Valikhnovskyi Institute of Surgery.
Publications by topic
- "Ways to improve outcomes in patients with facial keloid scars" - Clinical Anatomy and Operative Surgery, 2025 (DOI).
How treatment works with us
- Photo onlineSend a photo of the scar up close and from a distance and write when and after what it appeared.
- ConsultationExamination of all scars, discussion of previous treatment and family history of keloids.
- PlanWhere to start — silicone, injections, or laser — and whether excision with additional treatment is needed.
- TreatmentCourse over several months; excision — if necessary and only with additional methods.
- SupervisionRegular check-ups to notice in time if the keloid starts growing again.
08 / QUESTIONS AND ANSWERSCommon
Common
questions
Short answers. What is right for you, the doctor will tell you during the consultation.
How does a keloid differ from a regular scar?
Most regular scars fade over time, whereas a keloid continues to grow and extends beyond the wound. A hypertrophic scar is also thick, but it stays within the boundaries of the wound.
Is keloid dangerous?
A keloid is a benign formation. However, it can itch, hurt, interfere with movement, and affect well-being. A doctor can distinguish an unusual formation from a tumor.
Is it possible to get rid of a keloid completely?
Completely — no, but treatment helps make it less noticeable and reduce itching. Even after successful treatment, it can return, so check-ups are needed over a long period.
Is the tendency to form keloids inherited?
Heredity matters: in a study of 715 patients, people with keloids in the family had more severe cases. But there is currently no genetic test that could predict the risk.
I have had keloids. Can I undergo surgery?
Inform the surgeon about keloids in advance so that wound care can be planned taking the risk into account. Silicone on a healed scar may help, although the evidence is weak.
Will laser help?
Laser is used together with other methods, but according to a Cochrane review, there is currently insufficient evidence of its effectiveness for keloids. What will suit you, the doctor will say after examination.
Can I get tattoos or piercings if I am prone to keloids?
People prone to keloids are advised to avoid them: any skin damage can trigger a new keloid.
Sources
19 sources · guidelines, Cochrane reviews, systematic reviews, and NHSshowCollapse
- Diagnosis and Treatment of Keloids and Hypertrophic Scars-Japan Scar Workshop Consensus Document 2018Burns & Trauma, 2019doi:10.1186/s41038-019-0175-y ↗
- Updated international clinical recommendations on scar management: part 2--algorithms for scar prevention and treatmentDermatologic Surgery, 2014pubmed.ncbi.nlm.nih.gov/25068544 ↗
- Updated scar management practical guidelines: non-invasive and invasive measuresJournal of Plastic, Reconstructive & Aesthetic Surgery, 2014doi:10.1016/j.bjps.2014.04.011 ↗
- The Most Current Algorithms for the Treatment and Prevention of Hypertrophic Scars and Keloids: A 2020 Update of the Algorithms Published 10 Years AgoPlastic and Reconstructive Surgery, 2022doi:10.1097/PRS.0000000000008667 ↗
- The Epidemiology of KeloidsTextbook on Scar Management (Springer), 2020doi:10.1007/978-3-030-44766-3_4 ↗
- Global insights into keloid formation: An international systematic review of regional genetic risk factors and commonalitiesWound Repair and Regeneration, 2024doi:10.1111/wrr.13203 ↗
- Clinical and epidemiological analysis of keloids in Chinese patientsArchives of Dermatological Research, 2015doi:10.1007/s00403-014-1507-1 ↗
- Surgical Excision with Adjuvant Therapies in the Management of Keloids: A Systematic ReviewMedicina (Kaunas), 2026doi:10.3390/medicina62050916 ↗
- Optimizing Radiotherapy for Keloids: A Meta-Analysis Systematic Review Comparing Recurrence Rates Between Different Radiation ModalitiesAnnals of Plastic Surgery, 2017doi:10.1097/SAP.0000000000000989 ↗
- Post-excisional radiotherapy for keloid treatment: A systematic review and meta-analysisJournal of Plastic, Reconstructive & Aesthetic Surgery, 2026doi:10.1016/j.bjps.2025.11.016 ↗
- Silicone gel sheeting for preventing and treating hypertrophic and keloid scarsCochrane Database of Systematic Reviews, 2013doi:10.1002/14651858.CD003826.pub3 ↗
- Intralesional Cryotherapy for the Treatment of Keloid Scars: Evaluating EffectivenessPlastic and Reconstructive Surgery Global Open, 2015doi:10.1097/GOX.0000000000000348 ↗
- Laser therapy for treating hypertrophic and keloid scarsCochrane Database of Systematic Reviews, 2022doi:10.1002/14651858.CD011642.pub2 ↗
- Patient-reported outcomes for keloids: a systematic reviewGiornale Italiano di Dermatologia e Venereologia, 2019doi:10.23736/S0392-0488.18.06089-3 ↗
- Ways to improve the results of treatment of patients with keloid scars on the faceClinical Anatomy and Operative Surgery, 2025doi:10.24061/1727-0847.24.2.2025.20 ↗
- Keloid scarsNHS, 2023nhs.uk/conditions/keloid-scars ↗
- ScarsNHS, 2023nhs.uk/conditions/scars ↗
- Cuts and grazesNHS, 2026nhs.uk/conditions/cuts-and-grazes ↗
- CellulitisNHS, 2024nhs.uk/conditions/cellulitis ↗
The figures on the page are from these sources.
The scar is growing
and extending beyond the wound?
Send a photo of the scar. The doctor will say whether it is a keloid and suggest a treatment plan.