What Are Keloids and Hypertrophic Scars Understanding These Unusual Skin Growths
Keloids and hypertrophic scars are overgrown scars that rise above your skin after injury; learn signs, treatments, and care options—no referral.
Keloids and hypertrophic scars are raised scars that happen when your skin keeps building scar tissue even after the wound has closed. They can itch, feel tight, look darker than the surrounding skin, and keep changing for months, which is why they can feel so frustrating and unpredictable. Both start after skin injury such as acne, piercings, surgery, burns, or even small cuts. The key difference is that hypertrophic scars stay within the original wound edges, while keloids grow beyond them and can keep expanding. In this guide you’ll learn what they look and feel like, why they happen, how clinicians tell them apart, and what treatments tend to work best so you can choose your next step with more confidence. If you want help deciding whether what you’re seeing is a keloid, a hypertrophic scar, or something else, a quick conversation through PocketMD can help you sort out options and what to try first based on your skin type and the scar’s location.
Symptoms and signs you might notice
A raised, firm scar that thickens
You may feel a hard, rubbery bump or ridge where you expected a flat scar. It can keep getting thicker for weeks to months, which can make you worry that something is “still wrong” underneath. With hypertrophic scars, the thickening usually stays limited to the original cut or pimple area.
Growth beyond the original wound
If the scar spreads outside the borders of the original injury, that pattern points toward a keloid. It can look like the scar is “spilling over” into normal skin, even if the original wound was small. This matters because keloids often need a different treatment strategy and are more likely to come back after removal.
Itching, burning, or tenderness
Raised scars can itch intensely or feel prickly, especially as they are actively growing. Some people notice burning or soreness when clothing rubs the area or when the weather changes. These sensations are common and do not automatically mean infection, but they are a good reason to ask about symptom-relief options.
Tightness that limits movement
When a thick scar sits near a joint, your skin may feel tight when you bend or stretch. You might avoid certain movements without realizing it, which can slowly reduce flexibility. Early stretching guidance and scar massage (when appropriate) can make a real difference in comfort and function.
Color changes and shiny surface
A keloid or hypertrophic scar can look pink, red, purple, or darker brown than the surrounding skin, and it may appear shiny. Over time some scars fade, but others stay noticeably darker, which can be especially distressing on the chest, shoulders, jawline, or earlobes. If the scar suddenly becomes very red, hot, and increasingly painful, that is when you should be checked for infection.
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Why keloids and hypertrophic scars happen
An overactive healing response
After an injury, your body lays down collagen to close the gap, and then it usually remodels that collagen into a flatter scar. With keloids and hypertrophic scars, the “build” phase stays turned on longer than it should. The so-what is simple: even a well-healed wound can keep changing because the scarring process is still active under the surface.
Where the scar is on your body
Certain areas are under more tension or have different skin structure, which can push scars to thicken. The chest, shoulders, upper back, jawline, and earlobes are classic trouble spots. If your scar is in one of these zones, it is not your fault that it looks more dramatic than a scar on, say, your forearm.
Genetics and family tendency
Some people’s skin is simply more likely to form raised scars, and it can run in families. You might notice that multiple relatives have thick scars after piercings or surgery. Knowing your tendency helps you plan ahead for procedures and start prevention early rather than reacting after the scar has already grown.
Darker skin tones and certain ages
Keloids are more common in people with medium to deep skin tones, and they often show up in the teens through the 30s. That does not mean lighter skin cannot develop them, but the odds are different. If you are in a higher-risk group, it is worth being extra cautious with elective piercings and paying attention to acne control to reduce skin injury.
Repeated irritation or delayed healing
When a wound is repeatedly pulled, scratched, infected, or reopened, your body gets more signals to keep repairing. Acne picking, friction from straps, and poorly fitting jewelry can all keep the area inflamed. The practical takeaway is that protecting the wound and calming inflammation early can lower the chance that the scar becomes thick and persistent.
How doctors diagnose and assess raised scars
History and timeline of the scar
A clinician will ask what started it, how quickly it grew, and whether it has changed recently. Keloids often keep enlarging beyond the original injury, while hypertrophic scars usually peak and then slowly soften. Bringing photos from earlier weeks can help show the growth pattern when your memory is fuzzy.
Skin exam and border check
The exam focuses on the scar’s edges, thickness, color, and whether it is attached to deeper tissue. The “border test” is important because growth outside the original wound is a major clue for keloids. They will also look for signs of infection such as warmth, pus, or spreading redness.
Ruling out look-alikes
Most raised scars are straightforward, but some bumps can mimic them, such as cysts, dermatofibromas, or rarely skin cancers. If the lesion is ulcerating, bleeding easily, changing very fast, or looks unusual for a scar, your clinician may recommend a small sample (biopsy) to be safe. That step is about certainty, not panic.
When to seek urgent care
You should be seen quickly if a scar becomes suddenly very painful, hot, and swollen, especially if you also have fever or feel unwell, because that can signal infection. Rapidly spreading redness after a procedure or piercing also deserves prompt evaluation. If the scar is near your eye or airway area and swelling is affecting vision or breathing, treat it as urgent.
Treatment options that actually help
Silicone gel or silicone sheets
Silicone is often a first-line option because it can flatten and soften raised scars over time and reduce itch for many people. It works best when you use it consistently for weeks to months, which can be annoying but is usually worth it. Think of it as steady pressure and hydration that nudges your scar toward calmer remodeling.
Steroid shots into the scar
For thicker scars, clinicians often inject a steroid directly into the scar (intralesional steroid injection) to reduce inflammation and collagen buildup. The scar may feel less itchy and gradually flatten over several sessions. Side effects can include skin thinning or lightening around the area, which is why dosing and spacing matter.
Freezing treatment (cryotherapy)
Freezing can shrink some raised scars, and it is sometimes combined with steroid injections for better results. You may have blistering or temporary swelling afterward, and changes in skin color can happen, especially in darker skin tones. It can be a good option for smaller lesions, such as some ear keloids, when done carefully.
Laser or light-based therapy
Certain lasers can reduce redness and improve texture, which can make a scar look less “angry” even if it does not fully flatten. Laser treatment is often part of a combination plan rather than a one-and-done fix. If appearance is a major concern for you, ask specifically what outcome is realistic for your scar type and skin tone.
Surgery with recurrence prevention
Cutting out a keloid can feel like the obvious solution, but keloids often grow back if surgery is done alone. That is why clinicians usually pair removal with prevention steps such as steroid injections, pressure therapy, silicone, or sometimes targeted radiation in select cases. The goal is not just to remove tissue, but to prevent your skin from restarting the same overgrowth cycle.
Living with keloids or hypertrophic scars
Managing itch and irritation day to day
Itch can drive scratching, and scratching can keep the scar inflamed, so breaking that loop matters. Keeping the area moisturized and protected from friction often helps more than you expect. If itch is intense or keeping you up at night, ask about targeted anti-itch options rather than trying to “tough it out.”
Clothing, jewelry, and friction choices
Small changes can reduce daily aggravation, especially for chest, shoulder, and ear scars. Softer fabrics, looser straps, and avoiding heavy earrings can reduce pulling forces that keep scars thick. This is not about being delicate—it is about not feeding the scar constant mechanical stress.
Appearance concerns and confidence
Raised scars can make you feel self-conscious in photos, at the gym, or in intimate moments, and that emotional weight is real. Some people feel better after they have a plan, even before the scar changes, because uncertainty is exhausting. If you are spiraling about how it looks, it can help to talk with a dermatologist about what is realistically improvable and what is better camouflaged.
Tracking changes so you know what works
Scars change slowly, so it is easy to think nothing is happening and quit too early. Taking a photo in the same lighting every two to four weeks gives you a clearer view of progress. It also helps your clinician adjust treatment based on evidence rather than guesswork.
Prevention after injuries and procedures
Avoid elective skin trauma if you’re prone
If you have formed keloids before, new piercings and tattoos carry a higher risk of triggering another one. That is especially true for cartilage piercings and the chest or shoulder area. Choosing alternatives can save you months of treatment later.
Treat acne early to reduce scarring
Acne is a common starting point for raised scars because each inflamed pimple is a small skin injury. Getting acne under control reduces the number of “healing events” your skin has to manage. If you are getting deep, painful breakouts, it is worth asking for a treatment plan sooner rather than waiting for scars to accumulate.
Use early scar care after surgery
Once your incision is closed and your surgeon says it is safe, early scar care can reduce thickening. Silicone products and gentle protection from tension are common starting points. The timing matters because prevention is easier when the scar is still in its remodeling phase.
Sun protection to prevent darkening
Sun exposure can make scars stay darker for longer, which can make them stand out even if they flatten. Using sunscreen and covering the area when possible helps the color blend back toward your natural tone. This is one of the simplest steps with a surprisingly visible payoff.
Frequently Asked Questions
What is the difference between a keloid and a hypertrophic scar?
A hypertrophic scar stays within the borders of the original injury, even if it is thick and raised. A keloid grows beyond the original wound edges and can keep expanding over time. That difference matters because keloids are more likely to come back after simple removal and often need combination treatment.
Do keloids go away on their own?
Keloids usually do not fully go away without treatment, although they can sometimes soften or stop growing. Hypertrophic scars are more likely to improve gradually over time. If your scar is still enlarging after several months, it is reasonable to ask about active treatment rather than waiting indefinitely.
Why do keloids itch so much?
Itching often happens when the scar is actively remodeling and the skin’s nerve endings are irritated by inflammation and tight tissue. Dryness and friction can amplify the sensation, which is why moisturization and reducing rubbing can help. If itch is severe, targeted treatments such as steroid injections or prescription topicals may calm the process.
Is it safe to remove a keloid surgically?
Surgery can be safe, but keloids have a high recurrence risk when they are cut out without follow-up prevention. Many clinicians pair surgery with steroid injections, silicone or pressure therapy, and in select cases other add-ons to reduce regrowth. The best plan depends on the keloid’s location, size, and your history of scarring.
Are there any blood tests for keloids or hypertrophic scars?
There is no specific blood test that diagnoses keloids or hypertrophic scars, because the diagnosis is mainly based on how the scar looks and behaves over time. Labs can still be useful if you also have slow wound healing, frequent infections, or fatigue, since issues like anemia or high blood sugar can affect skin recovery. If that sounds like you, a broad baseline panel can be a practical starting point to discuss with a clinician.