Background

The Ultimate Guide to Keloids

Causes, Symptoms, Myths, and the most advanced treatments available in modern Dermatology.

By Dr. Caroline Minchio - Board-Certified Dermatologist
Methodology and Scientific Sources: This document was prepared based on guidelines from dermatology authorities, including publications from the National Library of Medicine (NIH), MedlinePlus, and review articles by dermatologists, as well as updated clinical conduct manuals. The information has been adapted to answer the main questions of patients in tropical climates and multiethnic populations, considering risk factors such as melanin-rich skin, high solar incidence, and humidity.
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Chapter 1: Basic Concepts & Causes

1. What is a keloid?
A keloid is an excessive and abnormal growth of scar tissue that extends beyond the boundaries of the original wound. Unlike a normal scar, it does not regress on its own and can continue to grow over time, forming a firm, rubbery, and usually raised mass.
2. What is the difference between a keloid and a hypertrophic scar?

Hypertrophic Scar: Remains restricted to the site of the initial injury. It can be thick and red but tends to regress over time.

Keloid: "Invades" the surrounding skin, growing almost like a "crab's claw". It goes beyond the boundaries of where the cut or scratch originally occurred.

3. Why do keloids form?
An error occurs in the skin's healing process. While in a normal scar collagen production eventually stops, in a keloid, the fibroblasts (cells that produce collagen) become hyperactive and do not stop working, producing excess collagen (up to 20 times more than normal skin).
4. Who is more prone to developing keloids?
This is very important: darker skin tones, including those of African, Asian, and Hispanic descent, have a much higher incidence, ranging from 4.5% to 16%. People under 30 are also more susceptible.
5. Are keloids hereditary?
Yes. If you have family members (parents, grandparents, siblings) with keloids, your chances of developing them are also significantly higher. Genetic tendency is one of the main risk factors.
6. What are the main causes?

Any injury to the skin can trigger it, even one you don't remember. The most common are:

  • Acne: Especially on the chest and back.
  • Piercings and tattoos: Very common on earlobes and eyebrows.
  • Surgeries: Including C-sections and minor dermatological surgeries.
  • Burns and vaccinations.

Chapter 2: Symptoms & Diagnosis

7. Do keloids itch or hurt?
Yes. About 86% of patients report itching (pruritus) and 46% feel pain, along with a burning sensation or discomfort upon touch or friction with clothing.
8. How do I know if I have a keloid or a skin tumor?
The diagnosis is primarily clinical (made by the dermatologist by looking and palpating). Only in cases of doubt is a biopsy performed to rule out other issues, such as a rare type of sarcoma called Dermatofibrosarcoma protuberans (DFSP).
9. Do keloids turn into cancer?
No. Keloids are benign. They do not turn into skin cancer. The problem is aesthetic and functional (symptoms), but there is no risk of malignancy.
10. Why does the keloid get dark in the sun?
Sun exposure stimulates melanin production in the scar. If the keloid is exposed to the sun during the first year of formation, it can darken permanently, becoming darker than your natural skin tone.
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Chapter 3: Prevention & Skin Care

11. How to avoid a keloid after a surgery or cut?

Prevention starts before surgery. For those with high-risk skin, the dermatologist or surgeon must use techniques that reduce tension on the wound.

For the patient: After the stitches are removed, use silicone sheets or gels for 12 to 24 hours a day for 2 to 3 months. This drastically reduces the risk.

12. Why do tropical climates worsen keloids?
Regions with high UV incidence year-round can darken and irritate keloids. Furthermore, humidity and heat increase sweating, which can intensify itching and irritation from friction. The recommendation is to use physical sun protection (covers or patches) over the scar.
13. Can someone prone to keloids get a tattoo or piercing?
It is a huge risk. Tattoos and piercings are deliberate traumas to the skin. In predisposed people, it is very common for an ear piercing or a chest/arm tattoo to result in a keloid. The general recommendation is to avoid them.
14. Does silicone really work for prevention?
Yes. The use of silicone sheeting or gel is one of the measures with the most scientific evidence for prevention and initial treatment. It hydrates the skin, regulates collagen production, and applies slight pressure that helps flatten the scar.
15. How should I care for a wound to prevent a keloid?
  • Keep the area clean and dry to prevent infection.
  • Avoid movements that stretch the area (especially if it is on the chest, back, or shoulders).
  • Use non-adhesive dressings and apply a thin layer of petroleum jelly until fully healed.

Chapter 4: Available Treatments

16. Can a keloid be cured?
It is a challenge. There is no magic "cure" that makes it disappear 100% and never come back. However, there are very effective treatments to flatten, lighten, stop the itching, and significantly reduce the size. Success is higher when more than one type of treatment is combined.
17. What is the most common and effective treatment?
Corticosteroid injection is considered the first line of treatment. Triamcinolone is generally used. Applications are given every 4 to 6 weeks, and improvement begins to be seen after a few sessions.
18. Is there laser treatment for keloids?
Yes. Lasers like the Pulsed Dye Laser (585nm) and Nd:YAG (1064nm) are excellent. They help flatten the scar, reduce redness (or vascularization), and improve itching. They are usually used in combination with injections.
19. Does cryotherapy (freezing) work?
Yes, mainly for smaller and older keloids. Freezing destroys the fibrous tissue. However, caution must be taken with darker skin, as it can cause permanent white spots (hypopigmentation).
20. Does removing the keloid with surgery solve it?
If it is just surgery (excision) without complementing it with another treatment, the recurrence rate (growing back) is extremely high, ranging from 45% to 100%. Therefore, surgery must be combined with corticosteroid injections during the surgery or with postoperative radiation therapy.
21. What is radiation therapy for keloids?
It is the application of localized radiation right after the surgical removal of the keloid (usually within 24 to 48 hours). This prevents the hyperactive fibroblasts from reforming the scar. It is a resource for severe and refractory cases but requires special care and is contraindicated in young people and pregnant women.
22. Is there a home remedy or ointment that works?
No "home" ointment (like aloe vera, lemon, etc.) will resolve an already formed keloid. There are silicone ointments that help in prevention, and corticosteroid ointments (by prescription) that can help with itching, but they do not eliminate the fibrous tissue.
23. What is 5-fluorouracil (5-FU)?
It is a medication (chemotherapy) used off-label for keloids. When injected together with the corticosteroid, it helps to "soften" the keloid and reduce local blood flow. It is an option for keloids that do not respond well to corticosteroids alone.
24. How many treatment sessions are needed?
Patience is key. The treatment is slow. Generally, 4 to 6 sessions are needed to start seeing a good result, and the total treatment can last from 6 months to 1 year or more, depending on the size, age, and location of the keloid.
25. What is the best treatment for ear keloids (piercing)?
Ear keloids are often "dumbbell" shaped. The most effective treatment is surgical excision followed by immediate infiltration of corticosteroid into the wound and the use of pressure plates (compression). Local radiation therapy is also widely used in this region to prevent recurrence.
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Chapter 5: Special Care & Environment

26. How does sun exposure affect the treatment?
The sun is one of the biggest enemies. Throughout the treatment (and even after), it is vital to protect the area with physical sunscreen or an opaque patch. Exposure not only darkens the keloid but can also reactivate inflammation and worsen itching.
27. Can I go to the beach or pool?

You can, but with restrictions:

Beach: Avoid exposing the keloid directly to the sun. Use a silicone cover or UV protection clothing. Seawater can dry it out but doesn't cause direct harm.

Pool: Chlorine can irritate the scar. Wash well with fresh water after getting out.

28. Does sweat worsen the keloid?
Yes. Sweat contains salts and can irritate the skin, increasing itching. Keeping the area clean, dry, and wearing light (cotton) clothing helps control symptoms, especially during hot summers.
29. Does health insurance cover the treatment?
Generally, yes. The treatment of keloids (injections, cryotherapy, and surgeries) is considered medical in nature (functional and reconstructive aesthetic). However, technologies like high-power lasers might not be covered by all plans, requiring verification of your specific coverage.
30. Which specialist should I see?
A Dermatologist is the most qualified specialist to diagnose and treat keloids, using everything from injections and lasers to surgeries. In very extensive or complex cases, there may be collaboration with Plastic Surgeons or Radiation Oncologists.

Chapter 6: Myths and Facts

31. "Keloids only appear from major surgeries." (Myth)
Even an insect bite, an ingrown hair (folliculitis), or a poorly treated pimple can generate a keloid in predisposed individuals.
32. "If I remove it, it grows back bigger." (Partial Truth)
If it is removed only with surgery, without follow-up injections or radiation therapy, the chance of it returning larger and more aggressive is extremely high. That is why the treatment should never be just cutting and suturing.
33. "Children cannot be treated for keloids." (Myth)
They can and should, but with care. Radiation therapy is generally avoided in children and adolescents due to the risk of long-term effects. The standard treatment for children is corticosteroid injections and silicone.
34. "Pregnancy worsens keloids." (Truth)
The incidence of keloids is higher during pregnancy and puberty, likely due to hormonal changes that affect skin growth factors.
35. "Eating pork or 'dark' foods causes keloids." (Myth)
There is absolutely no scientific proof that specific foods cause or worsen keloids. Formation is genetic and inflammatory, not dietary.

Chapter 7: Symptom Relief at Home

36. What can I do to stop the itching right now?
  • Cold compresses or ice wrapped in a cloth.
  • Gentle massage with moisturizer or silicone gel.
  • Avoid scratching, as mechanical trauma stimulates growth.
  • In extreme cases, a doctor may prescribe oral antihistamines.
37. Does massage help?
Yes. Gentle and continuous massage helps soften the fibrosis, improves local circulation, and can help reduce the feeling of tightness. Always use it with a moisturizer or silicone gel so as not to damage the skin.
38. Is there a tape for keloids?
Yes. There are micropore or silicone tapes that can be used for pressure and occlusion therapy. They are especially effective after surgeries, keeping the scar "compressed" to prevent it from elevating.
39. Can I use makeup to cover it?
You can, as long as the skin is completely closed (no open wounds). Use special coverage makeup for scars, but remember: before applying makeup, apply sunscreen, as keloid skin is very sensitive to light.
40. What is "infiltration" and does it hurt a lot?
Infiltration is the injection of the medication directly into the keloid. It can hurt, especially at first, because the tissue is very hard. However, after the first session, the tissue softens and the applications become less painful. Using cryotherapy before the injection can help decrease the pain and soften the site.

Chapter 8: Specific Cases

41. Are keloids from acne on the chest and back common?
Extremely common. Severe acne in these regions can evolve into keloids, often with "claw-like" extensions. Treating active acne is the best prevention.
42. C-section keloid: what to do?
It is one of the most common. Treatment can be started with silicone plates and compression. If there is no improvement, corticosteroid infiltrations are the first line. Surgical revision is only indicated if combined with radiation therapy or potent injections.
43. An inflamed piercing turned into a keloid. Should I remove it?
Yes, remove the piercing immediately. Maintain local pressure with ice and seek a dermatologist. The earlier the treatment (with steroid injection), the greater the chance of avoiding permanent growth.
44. Tattoo with a keloid: how to treat it?
Treating a keloid over a tattoo is delicate, as many treatments (laser, corticosteroids) can fade or distort the ink. Careful planning with a dermatologist is necessary to try to preserve the design while treating the fibrosis.
45. Keloid on the earlobe after a piercing
It is one of the sites with the highest tension and recurrence. The gold standard treatment is surgical excision associated with superficial radiation therapy (brachytherapy) or intraoperative corticosteroid infiltration, in addition to the use of compression earrings to maintain the result.

Chapter 9: New Technologies & Research

46. What is RF Microneedling?
It is a technology that combines microneedles that puncture the keloid with the release of radiofrequency energy. This helps to remodel collagen, break down fibrosis fibers, and improve skin texture. It is a good adjunctive option.
47. Is there a vaccine for keloids?
No. Research is looking for drugs that inhibit the TGF-beta growth factor (the main cause of fibrosis), but there is still no "vaccine" or single systemic drug that cures a keloid.
48. Does Imiquimod work?
Imiquimod is a cream that modulates immunity. There are studies showing that applying it after surgery can reduce recurrence rates. It is an option for prevention in high-risk patients.
49. Does a home treatment with rosehip oil help?
Rosehip oil is a good moisturizer and helps with overall skin texture, but it has no proven efficacy in reducing the fibrotic mass of an established keloid. It can be used as an adjuvant to improve elasticity.
50. How to choose the best treatment?
There is no single treatment. Current dermatology recommends combination therapy (e.g., corticosteroids + laser, or surgery + radiation therapy). The choice depends on the location, size, time of evolution, skin color, and symptoms. A detailed consultation is essential to create an individualized and realistic plan.

10. Research Sources and Clinical References

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