Skip to main content

Health condition · Clinically reviewed

Keloid scars, silicone, steroid, laser - and when surgery only works with an adjuvant.

Keloids are not just stubborn scars. They are a distinct, genetically driven overgrowth - and they respond best to a patient, combined plan rather than any single treatment.

Jump to treatment
A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against BAD, NICE and peer-reviewed scar-management literature you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK practice including silicone, intralesional steroid, laser and combined excision-plus-adjuvant protocols.

Key facts

Keloid scars at a glance.

The essentials, in plain English - what a keloid actually is, who is at risk, and how it is treated in the UK today.

  • What it is

    A benign but stubborn overgrowth of scar tissue that extends beyond the boundary of the original wound - genetically driven and often progressive.

  • Not the same as hypertrophic

    Hypertrophic scars stay within the original wound and often settle; keloids grow beyond it and rarely regress on their own.

  • Who is affected

    Anyone can develop one, but the risk is up to fifteen times higher in Fitzpatrick IV to VI skin - African-Caribbean, South Asian and Hispanic backgrounds especially.

  • Common sites

    Chest, shoulders, upper back, earlobes (after piercing), jawline and upper arms - areas of tension and sebaceous activity.

  • First-line care

    Silicone gel or sheeting worn daily for months, combined with intralesional triamcinolone in a specialist clinic.

  • Prevention

    For people prone to keloids, avoiding unnecessary surgery and piercings - and treating any new wound early - matters more than any single therapy.

Why this guide matters

A combined plan, not a single quick fix.

Keloids reward patience and combination therapy. The three ideas below shape every treatment decision on this page.

  • Keloids are not slow scars

    They are a distinct process - genetically driven, growing beyond the wound and rarely resolving on their own. The treatments are different from a normal scar.

  • Combination beats monotherapy

    Silicone plus steroid, or excision plus radiotherapy - combined approaches consistently outperform any single treatment on stubborn lesions.

  • Prevention is worth as much as cure

    For keloid-prone people, avoiding unnecessary surgery and piercings and treating fresh wounds early prevents lesions that are hard to erase later.

How the diagnosis is made

From a growing scar to a clear plan.

Keloid is a clinical diagnosis. The steps below are what a UK GP, dermatologist or plastic surgeon will normally follow, in order.

  1. 01

    Assessing

    History and trigger

    When the lesion appeared, what the original injury was, how it has changed, and whether other scars have behaved the same way.

  2. 02

    Assessing

    Clinical examination

    A firm, rubbery, raised lesion that extends beyond the original wound margin - often itchy, tender and progressive.

  3. 03

    Assessing

    Distinguishing from hypertrophic

    Hypertrophic scars respect the wound edge and often flatten with time. Keloids do not - a distinction that shapes every treatment decision.

  4. 04

    Confirming

    Photographic record

    A baseline photograph in the clinic notes lets you and your clinician judge change objectively over the months of treatment.

  5. 05

    Confirming

    Impact assessment

    Itch, pain, restricted movement and cosmetic distress are measured - keloids affect quality of life as much as any inflammatory skin disease.

  6. 06

    Preparing

    Dermatology or plastics referral

    Larger, symptomatic or functionally limiting keloids are managed by a specialist dermatologist or plastic surgeon with a scar interest.

  7. 07

    Preparing

    MDT planning where indicated

    Complex or recurrent lesions may involve combined dermatology, plastic surgery and clinical oncology (for adjuvant radiotherapy).

Typical timeline: a first visit to a settled plan in a few clinic sessions, with treatment reviewed over months.

Symptoms

What a keloid actually looks and feels like.

A firm, rubbery, raised lesion that has crossed the boundary of the original wound - usually itchy, sometimes tender, and often still slowly changing.

  • Raised, firm nodule

    A rubbery, dome-shaped lesion that sits proud of the skin - shiny surface and often a red or purple hue in early lesions.

  • Growth beyond the wound

    The defining feature - keloid extends past the original injury, often as claw-like projections into normal skin.

  • Itch and tenderness

    Pruritus and discomfort are common, especially in early, actively growing lesions - and are a genuine target for treatment.

  • Progressive enlargement

    Unlike a normal scar, a keloid may keep growing for months or years - a key clue that it is not simply a slow-to-fade scar.

  • Colour change over time

    Early lesions look red or violaceous; older ones become paler or hyperpigmented, especially in richly pigmented skin.

  • Site pattern

    Chest, shoulders, upper back, earlobes and jaw are classic - areas of skin tension or piercing sites.

  • Family and personal history

    A parent or sibling with keloids, or a previous keloid of your own, raises the risk of another after any new injury.

  • Functional limitation

    Contractures across a joint, breathing restriction over the chest or ear-canal obstruction are strong reasons for earlier specialist input.

Treatment

How keloid scars are treated in the UK.

Silicone and intralesional steroid first, laser and other office therapies next, with surgery reserved for combined plans in specialist hands.

  • Silicone gel or sheeting

    First-line and preventive - worn for at least 12 hours a day for three to six months, softening lesions and easing itch.

  • Intralesional triamcinolone

    Kenalog 10 to 40 mg per mL injected into the lesion every four to six weeks - the most reliably effective office treatment.

  • Intralesional 5-fluorouracil

    Used alone or combined with steroid for resistant lesions - a specialist dermatology option in selected patients.

  • Cryotherapy

    Contact or intralesional cryotherapy for smaller keloids, often paired with steroid - specialist-delivered.

  • Laser therapy

    Pulsed-dye and Nd:YAG lasers reduce redness, itch and thickness; fractional laser can soften mature scars - see /treatments/pigment-laser/.

  • Surgical excision

    Considered only when combined with an adjuvant such as steroid, radiotherapy or pressure - excision alone recurs in most cases.

  • Adjuvant radiotherapy

    Low-dose post-excision radiotherapy is offered by specialist centres for high-risk or recurrent keloids where the benefit outweighs the risk.

  • Pressure therapy

    Custom compression garments or ear clips worn for months after excision - the mainstay for post-surgical earlobe keloid prevention.

Other options seen in specialist practice include intralesional bleomycin, topical onion extract, tacrolimus or imiquimod, and emerging targeted therapies such as dupilumab (see /treatments/dupilumab-clinic/) - reserved for selected patients under specialist supervision.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards on scar management, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP, dermatologist or plastic surgeon knows your skin, your scars and your history and can tell you which parts apply to you.

  • British Association of Dermatologists. Patient information leaflet on keloid scars.

  • International Advisory Panel on Scar Management. Updated international clinical recommendations on scar management.

  • NICE Clinical Knowledge Summaries. Scars - keloid and hypertrophic.

  • European Dermatology Forum. Guideline on the management of hypertrophic scars and keloids.

Red flags

When a keloid needs specialist attention.

Most keloids are managed in outpatient clinics. These are the features that mean earlier or combined specialist input matters.

  • Rapid, painful growth

    A keloid that enlarges quickly or becomes acutely painful should be reviewed promptly - and any new lump with atypical features considered for biopsy.

  • Ulceration or bleeding

    Persistent ulceration or spontaneous bleeding is uncommon in stable keloids and warrants specialist review to exclude other diagnoses.

  • Functional restriction

    Any keloid that limits joint movement, chest expansion or hearing needs earlier plastic surgery input rather than watchful waiting.

  • Recurrence after excision

    A lesion that returns - often larger - after surgery signals the need for combined treatment with steroid, radiotherapy or pressure.

  • Psychological distress

    Visible chest, jaw or facial keloids carry a real mental-health burden - a compassionate mood assessment belongs in the plan.

  • Suspicion of another diagnosis

    Firm nodules that pre-date any injury, or lesions with atypical features, may need biopsy to exclude dermatofibrosarcoma protuberans or scar sarcoidosis.

  • Considering elective surgery or piercing

    Anyone with a personal or family history of keloids should discuss the risks before elective procedures - and plan preventive care in advance.

  • Steroid atrophy or telangiectasia

    Repeated intralesional steroid can thin surrounding skin - a signal to space injections or switch to an alternative.

  • Post-radiotherapy concerns

    Post-excision radiotherapy carries a small long-term risk - reviewed carefully by specialist centres for younger patients.

Living with it

A treatable process, with a patient, layered plan.

Four habits that make the biggest difference over the year of care that most keloids need - daily silicone, patience with treatment, avoiding new triggers, and getting specialist input early.

A quiet reminder

Consistency beats intensity, every time.

A few small habits kept up for six to twelve months do more than a burst of aggressive treatment that then stops.

  1. 01 Routine

    Silicone every day

    The single most important self-care step - silicone gel or sheeting worn daily for months, kept up long after the lesion looks quieter.

  2. 02 Patience

    Think in months, not weeks

    Keloids respond slowly. A course of injections plus silicone is judged at three to six months, not three sessions.

  3. 03 Prevention

    Avoid new triggers

    Skip unnecessary piercings, elective cosmetic surgery on high-risk sites and any wound left to heal by tension - and treat new cuts early.

  4. 04 Escalate

    Get specialist input early

    If a scar is growing beyond the wound, itching or thickening at three months, ask for a dermatology or plastics referral - early treatment works best.

Frequently asked

Everything we get asked about keloid scars.

Quick answers on silicone, steroid injections, laser, surgery and how to prevent new lesions.

  • What is a keloid scar?

    A keloid is an overgrowth of scar tissue that extends beyond the original wound edge. It is firm, raised, often itchy or tender, and rarely regresses on its own. It differs from a hypertrophic scar, which stays within the wound and often settles with time.

  • Why do some people get keloids and others do not?

    Keloid tendency is largely genetic - inherited as an autosomal dominant trait with variable penetrance - and is far more common in Fitzpatrick IV to VI skin. Wound tension, delayed healing, puberty and pregnancy all increase the risk in susceptible people.

  • What is the difference between a keloid and a hypertrophic scar?

    Hypertrophic scars are raised but stay within the boundaries of the original wound and often flatten over one to two years. Keloids grow beyond the wound margin, persist indefinitely and are much more likely to recur after simple excision. The distinction matters because their treatments and prognosis differ - see our guide at /conditions/burns-and-scars/.

  • Can a keloid be removed by surgery?

    Surgery alone recurs in most cases, often with a larger lesion than before. Excision is only offered when it can be combined with an adjuvant - intralesional steroid, low-dose radiotherapy or long-term pressure therapy - to reduce that risk.

  • How well do steroid injections work?

    Intralesional triamcinolone is the most reliable office treatment for symptomatic keloids. It softens the lesion, reduces itch and can flatten it over several sessions given four to six weeks apart. Combining it with silicone or laser improves results in stubborn lesions.

  • How can I stop new keloids from forming?

    If you are keloid-prone, avoid elective piercings and unnecessary cosmetic surgery on high-risk sites, use silicone gel or sheeting on any new wound for three to six months, and ask about early intralesional steroid if a scar starts to raise. Discuss prevention with a dermatologist before any planned procedure.

Related content

Keep reading.

Pulse Healthcare concierge

Send us your enquiry

A concierge service for UK private healthcare. We match you with the best vetted clinics and consultants in our network - they then contact you directly.

So we can match you to the right clinician close to you.

We reply to every enquiry within 24 hours (Mon–Fri). Confidential - your details are never shared outside our vetted consultant network.