How Do Keloids Differ from Hypertrophic Scars?
Both result from excessive collagen proliferation during wound healing. Hypertrophic scars remain confined within the boundaries of the original wound, develop early, and may gradually fade and flatten after 1–2 years. In contrast, keloids extend beyond the original wound margins, continue to grow over months or even years, do not regress spontaneously, and are often accompanied by noticeable itching and pain. Keloid formation is linked to individual predisposition and genetics; individuals with a history of keloids are highly prone to developing them at new wound sites.
Common Locations and Causes
Chests, shoulders, upper arms, earlobes (after piercings), jawlines (after cystic acne), and surgical sites. Any skin injury—inflammatory acne, piercings, surgery, burns, tattoos, chickenpox—can trigger keloid formation in predisposed individuals.
Why Simple Surgical Excision Is Not Recommended
Excision creates a new wound in an individual predisposed to keloids, and the recurrent scar is often larger than the original one. Surgical intervention is only considered when immediately combined with recurrence-prevention modalities (postoperative intralesional injections, pressure therapy, or superficial radiation therapy in select cases) and reserved for extensive scars that fail to respond to injections.
Evidence-Based Treatments
Intralesional corticosteroid injections administered every 3–6 weeks over multiple sessions help soften, flatten the scar, and relieve itching; other intralesional agents may be combined in refractory cases. Vascular lasers help reduce erythema and itching. Pressure garments and silicone gel sheets support healing and prevent recurrence. Cryotherapy is utilized for smaller scars. Results develop gradually, requiring recurrence monitoring for at least 1 year.
What BonBoz Does
Our dermatologists conduct clinical assessments to differentiate keloids from hypertrophic scars and rule out other lesions; design an intralesional injection regimen with scheduled follow-up milestones, combined with laser or pressure therapy when appropriate; and provide scar prevention guidance for new wounds in predisposed individuals. We maintain transparent communication: a keloid is a chronic scar tissue condition where the treatment goal is to flatten, soften, relieve itching, and prevent regrowth—not to 'completely erase' it.
