KELOID SCAR TREATMENT

Every wound leaves a scar. A keloid is what happens when the healing process overshoots and does not switch off.

The distinction that matters clinically is between a keloid and a hypertrophic scar. A hypertrophic scar is raised but stays within the boundary of the original wound, and it often flattens over a year or two on its own. A keloid grows past the original wound into surrounding normal skin, and it does not regress. They can be itchy and tender, and they keep expanding.

Keloids are more common in some people than others, particularly in darker skin, and they run in families. They favour the earlobes and the helix, the rim of the ear, along with the chest, shoulders, upper back and jawline, and they commonly follow previous surgical scars, a caesarean scar, or a piercing. Earlobe keloids after piercing are the single most common presentation we see, and they are also among the most treatable. Which type you have changes the plan entirely, which is why the assessment is not a formality.

This is the most common question we are asked, and the answer changes what you should do. After a piercing, especially the nose, ear cartilage or belly button, a lump can appear, and it is not always a keloid.

• An irritation bump, or a granuloma, tends to appear soon after the piercing, stays small, sits right at the piercing site, and often settles with good aftercare or once the jewellery is changed.
• A keloid grows over weeks and months, spreads beyond the piercing itself into normal skin, is firm and does not settle on its own, and is more likely if you or your family keloid easily

Earlier is easier. A keloid that has been growing for years is harder to treat than one that started six months ago.

• It is still growing. An active keloid responds better than a long-established one.
• It itches, stings or is tender, which is common and treatable.
• It is on your earlobe after a piercing, the most common and most treatable presentation.
• It restricts movement, across a joint or the front of the chest.
• You have had one cut out before and it came back bigger, which tells us surgery alone is not the answer for you.
• You are planning surgery or a piercing and you keloid easily. Preventive treatment planned in advance works far better than treating the result.

If you know you form keloids, tell any surgeon before any operation, including ours. It changes how a wound should be closed and managed.

Steroid injections are uncomfortable rather than painful, and the scar can feel sore for a day or two afterwards. Two side effects are worth knowing about in advance: the skin over the scar can lighten, which is more noticeable in darker skin, and the tissue under it can thin slightly. Both are usually mild, and both are reasons to space injections properly rather than chase a fast result.

Where surgery was involved, scar management continues for months. Silicone, pressure and further injections may all be part of it. This is the part people skip, and it is the part that decides whether the keloid comes back, so we would rather be clear about the commitment at the start than lose the result at month four.