Keloid scars are a type of abnormal scarring that occurs when the body’s healing process becomes overly active. Instead of stopping once the wound is closed, the scar continues to grow, often expanding beyond the original injury. These scars do not fade with time and can last for years without shrinking.
They appear as raised, firm, and often shiny patches on the skin. The color may range from flesh-toned to red or dark brown. Common areas include the chest, shoulders, earlobes, and upper back—though they can form anywhere on the body.
Keloids are not dangerous or contagious, but they can be uncomfortable and emotionally distressing. Some people experience itching, tenderness, or pain. Others feel self-conscious, especially if the scars are large or located in visible places. Although they’re not life-threatening, keloids can be difficult to treat and often return after removal.
Learning what causes keloid scars, who is at risk, and how to manage them is important for both medical professionals and those who may develop them. Early recognition and care can prevent complications, while tailored treatments offer relief for those already affected.
1. What Are Keloid Scars?
Keloid scars belong to the broader category of hypertrophic scars, but they are more aggressive. Unlike hypertrophic scars, which stay within the wound’s borders and may fade over time, keloids grow past the original site and rarely shrink on their own.
They form when fibroblasts—the cells responsible for tissue repair—produce too much collagen. This collagen builds up in a disorganized way, creating thick, firm, and sometimes rope-like scars.
Keloids can feel tight or even restrict movement, especially if they’re near joints. Under the microscope, they show dense, irregular bundles of collagen and fewer blood vessels. This makes them a type of benign fibroproliferative disorder, meaning they involve excessive tissue growth but are not cancerous.
2. Who Is at Risk for Keloid Scars?
Several factors increase the risk of developing keloid scars. Genetics is one of the strongest influences. If keloids run in your family, your chances of getting them are higher. People with darker skin—especially those of African, Asian, or Hispanic background—are also more likely to develop keloids. In African populations, the rate may be as high as 16%, compared to much lower rates in European populations.
Age matters too. Keloids most often appear between the ages of 10 and 30. They are rare in young children and older adults. Hormonal changes during puberty or pregnancy may also play a role in scar formation.
External triggers include anything that injures the skin. This might be surgery, piercings, acne, insect bites, burns, or even minor scratches. Poor wound care, infections, or repeated trauma to the same spot can raise the risk further.
3. Why Do Keloids Form?
The exact cause of keloid scars is still being studied, but researchers believe it involves a mix of immune signals, growth factors, and disrupted healing pathways.
Normally, the body stops producing collagen once a wound has healed. In people prone to keloids, that “stop” signal doesn’t work well. Fibroblasts stay active and keep making scar tissue long after it’s needed.
Genetic changes may also affect how the body handles inflammation and tissue repair. Some people have higher levels of TGF-β, a growth factor that promotes collagen production. This leads to ongoing growth, long after the wound has closed.
4. How Keloids Affect Daily Life
Even though keloids are not harmful to your health, they can still affect your quality of life. People often report feeling embarrassed or frustrated, especially when scars are large or hard to hide. Itching, pain, and tightness can interfere with sleep, daily tasks, or wearing certain clothes.
When keloids appear on the face or near joints, they may cause more distress. In children and teenagers, the emotional impact can be especially strong—some face teasing or bullying, which lowers self-esteem.
Treatment can also be discouraging. Keloids are known for coming back, even after surgery or laser treatment. That’s why emotional support and counseling are sometimes just as important as physical treatment.
5. Common Sites and Triggers
Keloid scars tend to form in areas that experience pressure, stretching, or frequent movement. Common locations include:
- Earlobes (after piercings)
- Chest and upper back (often from acne or injury)
- Shoulders (from injections or cuts)
- Jawline and cheeks (especially in acne-prone skin)
- Scalp (after hair procedures or infections)
Even small injuries—like shaving nicks, bug bites, or irritation from tight clothing—can lead to a keloid in people who are genetically predisposed. A scar may start as a small bump and grow over time, even when the original wound seemed harmless.
6. How to Tell Keloids from Other Scars
Keloids can look similar to other raised scars, but there are key differences. Hypertrophic scars stay within the boundary of the wound and may shrink over time. Keloids, on the other hand, grow past the original wound and usually stay raised unless treated.
Doctors usually diagnose keloids based on their appearance and your medical history. In some cases, a small tissue sample (biopsy) may be needed to confirm the diagnosis. Keloids can sometimes be mistaken for skin nodules or growths like dermatofibromas, so proper evaluation is important.
Final Thoughts
Keloid scars are a unique challenge in dermatology. While they’re not dangerous, they can have a lasting emotional and physical impact. Their tendency to grow unpredictably, resist treatment, and recur makes them frustrating for patients and doctors alike.
Understanding how and why they form can help prevent them or treat them more effectively. Early action and careful wound care are key. As science continues to uncover the biological pathways behind keloid formation, new treatments may offer longer-lasting solutions and relief.
