Keloid scars: causes, treatments and prevention
A keloid scar is a scar that "overflows": rather than remaining within the boundaries of the original wound, it proliferates and invades healthy surrounding skin. Often unsightly, and sometimes causing itching or pain, it can have a real impact on quality of life. The good news: effective treatments exist, provided they are combined intelligently. Here is everything you need to know.
Keloid or hypertrophic scar?
These two types of thickened scars are frequently confused, but their progression differs radically.
The hypertrophic scar
Thick and red, it remains confined to the boundaries of the original wound. It tends to improve spontaneously over the course of months and responds well to straightforward treatments.
The keloid scar
It extends beyond the edges of the original scar, spreads onto healthy skin, and does not resolve on its own. It may continue to grow over time and recurs easily after simple excision — hence the need for a combined treatment strategy.
Who is affected?
Darker skin tones
Higher phototypes carry a significantly greater risk of developing keloids.
Personal or family history
A genetic predisposition exists: having previously developed a keloid increases the likelihood of recurrence.
Younger individuals
Keloids occur more readily in adolescents and young adults.
Certain areas of the body
The sternum, shoulders, back, and earlobes (after piercing) are the most commonly affected sites.
Available treatments
No single treatment is perfect: it is their combination, tailored to each case, that yields the best results.
Corticosteroid injections
The first-line treatment. Injected directly into the keloid during repeated sessions, corticosteroids flatten it, soften it, and relieve itching and pain.
Combined surgery
Surgical excision is never performed in isolation, as recurrence occurs in the majority of cases. It is always combined with a complementary treatment (injections, compression therapy, sometimes superficial radiotherapy) to consolidate the result.
Compression therapy and silicone dressings
Prolonged use of silicone dressings or compressive devices (particularly for earlobes) complements the overall management and helps prevent recurrence.
Good to know: if you are predisposed to keloids, always inform your surgeon before any procedure. Preventive measures can be put in place from the very start of the healing process to limit the risk.
Frequently asked questions
What is the difference between a keloid scar and a hypertrophic scar?+
A hypertrophic scar remains confined to the boundaries of the original wound and tends to regress spontaneously over time. A keloid, by contrast, extends beyond the limits of the original scar, invades surrounding healthy skin, and does not resolve on its own. This distinction guides the choice of treatment.
Who is at risk of developing a keloid?+
People with darker skin tones (higher phototypes), younger individuals, and those with a personal or family history of keloids are more susceptible. Certain areas of the body are also more prone: the chest (sternum), shoulders, back, and earlobes (following a piercing, in particular).
Can a keloid be permanently removed?+
Surgery alone carries a high risk of recurrence, sometimes producing an even larger keloid. For this reason, excision is always combined with a complementary treatment (corticosteroid injections, compression therapy, sometimes superficial radiotherapy) to significantly reduce the risk of recurrence. No treatment guarantees the complete absence of recurrence, but combining techniques yields very good results.
Are corticosteroid injections painful?+
Intra-lesional corticosteroid injections cause brief discomfort. They are often the first-line treatment: repeated at intervals of a few weeks, they flatten the keloid and relieve itching and pain. Several sessions are generally required.
How can a keloid scar be prevented?+
In at-risk individuals, prevention is essential: avoid unnecessary procedures (piercings on sensitive areas), protect every scar from sun exposure for one year, and implement early measures (silicone dressings, compression therapy) as soon as healing begins. Informing your surgeon of your history before any procedure allows preventive strategies to be put in place from the outset.
Have a keloid scar assessed in Paris
Every keloid is different: only a clinical examination allows the most appropriate treatment strategy to be proposed. Dr. de Clermont-Tonnerre sees patients in Paris 16th and in Pontoise to evaluate your scar and establish a treatment plan.