Scars and Keloids: Prevention and Treatment

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

The two look similar at first, but they behave differently over time, and that difference guides treatment:

Depressed scars, such as acne or chickenpox scars, are a different type caused by loss of collagen, and they have different treatments.

• Hypertrophic scar: raised and red, stays within the wound edges, appears within weeks, and often flattens gradually over a year or more.
• Keloid: extends beyond the original wound, may appear months later, keeps growing and does not usually regress on its own.
• Both can cause itching, pain or tightness of the skin.
• Keloids are more likely to return after treatment.

Who is most prone to keloids, and where do they appear?

Keloids are more likely in people with darker and medium skin tones, in those with a family history, and are most common between the teenage years and age thirty. The strong sun in our region also affects new scars, which can become darker and more noticeable if not protected.

Keloids appear most often on the earlobes, chest, shoulders, upper back and jawline. They can follow very minor injuries, such as ear piercing, acne, vaccination or burns, as well as surgical wounds such as a caesarean section.

Being prone to keloids does not mean every wound will become one, but it does mean prevention deserves extra attention. If you know that you or a parent tends to form them, treat inflamed acne early, do not pick at spots, and tell any doctor performing a skin procedure beforehand.

How can I reduce the risk of scarring after a wound or surgery?

Good wound care from day one reduces inflammation and improves how the scar looks later. Follow the instructions of the doctor who treated the wound or performed the surgery. Helpful general steps include:

• Keep the wound clean, covered and moist with a simple ointment such as petroleum jelly, rather than letting it dry and crust.
• Do not pick the scab or scratch the wound.
• Once the skin has fully healed, your doctor may advise silicone gel or sheets for several weeks or months.
• Protect a new scar from the sun with sunscreen or by covering it for about a year.
• If you are prone to keloids, tell your surgeon before any operation, and avoid piercings and cosmetic tattoos.

What are the treatment options for keloids and hypertrophic scars?

A dermatologist chooses treatment based on the scar's size, age, location and symptoms, and often combines more than one method, as a single treatment may not be enough:

• Silicone gel or sheets, a first-line option for newer scars.
• Corticosteroid injections into the scar over several sessions, weeks apart, to flatten it and ease itching and pain.
• Cryotherapy with liquid nitrogen, especially for small scars.
• Laser to reduce redness or improve texture, depending on the type of scar.
• Other medicines injected into the scar, decided by the specialist for stubborn cases.
• Surgical removal, usually combined with another treatment afterwards, because removing a keloid on its own carries a high risk of recurrence.

What about earlobe keloids after piercing?

Earlobe keloids are among the most common types and sometimes appear months after piercing. Do not cut or tie them off at home, as this can cause infection and make them come back larger.

After removal, doctors usually add a supporting treatment such as corticosteroid injections, and may advise special pressure earrings for several months to reduce recurrence. Anyone who has had a keloid on an ear is best advised not to pierce it again.