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Health condition · Clinically reviewed

Keloid scars, silicone, injections, laser - and when to bring in surgery and radiotherapy.

Keloids are stubborn but treatable. The best results come from a stepped plan built around the scar in front of you, not a single procedure. See also our companion guide on the singular keloid scar.

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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, international scar consensus and peer-reviewed sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK practice including silicone therapy, intralesional steroid plus 5-FU, laser and post-excision radiotherapy.

Key facts

Keloid scars at a glance.

The essentials, in plain English - what a keloid is, how it differs from a hypertrophic scar, and how it’s treated in the UK today.

  • What it is

    A benign fibroproliferative scar that grows beyond the borders of the original wound and rarely regresses without treatment.

  • Not the same

    Different from a hypertrophic scar - keloids extend past the wound edge, hypertrophic scars stay within it.

  • Who it affects

    Anyone can develop one, but risk rises sharply in Fitzpatrick skin types IV to VI and with a family history of keloids.

  • First-line care

    Silicone gel or sheeting worn daily for months - the best-evidenced conservative option and safe for early scars.

  • Injection therapy

    Intralesional triamcinolone, often combined with 5-fluorouracil, flattens and softens established keloids over several sessions.

  • Recurrence

    Excision alone recurs in most cases - adjuvant steroid, radiotherapy or pressure is essential after surgery.

Why this guide matters

A combined plan, not a single procedure.

Keloid scarring is common, treatable and - with the right ladder - usually controllable. The three points below shape everything else on this page.

  • Silicone is foundational

    For new and early scars, medical-grade silicone worn daily for months is the best-evidenced conservative option and safe for almost everyone.

  • Injections do most of the work

    Intralesional triamcinolone, often combined with 5-fluorouracil, flattens established keloids and eases itch - repeat courses over months are the norm.

  • Surgery always needs an adjuvant

    Excision on its own recurs in most patients. Reliable results come from surgery paired with steroid, radiotherapy or pressure - planned before the operation.

How the diagnosis is made

From first raised scar to a clear plan.

The steps a UK GP, dermatologist or plastic surgeon will normally follow, in order - so you know what to expect and why.

  1. 01

    Assessing

    Skin exam and history

    A structured look at the scar - site, size, symptoms, growth over time and how it started (piercing, acne, surgery, trauma or spontaneous).

  2. 02

    Assessing

    Keloid versus hypertrophic

    Keloids grow beyond the original wound and rarely settle. Hypertrophic scars stay within it and often flatten over 12 to 18 months.

  3. 03

    Assessing

    Symptom and impact review

    Itch, pain, tightness and psychological distress all inform treatment - a scar can be flat and still cause misery.

  4. 04

    Confirming

    Fitzpatrick skin typing

    Skin type guides laser choice, cryotherapy risk and pigmentation-safe protocols - particularly important for types IV to VI.

  5. 05

    Confirming

    Photography and measurement

    Standardised photographs and Vancouver or POSAS scoring track response objectively across months of treatment.

  6. 06

    Planning

    Multidisciplinary planning

    Complex or recurrent keloids benefit from combined dermatology, plastic surgery and clinical oncology input before any excision.

  7. 07

    Planning

    Adjuvant plan before surgery

    If excision is considered, the adjuvant plan - steroid, radiotherapy or pressure - is agreed before the operation, not after.

Typical timeline: a first visit to a settled plan in weeks, results over months.

Symptoms

What keloid scars actually look and feel like.

The classic mix of raised, growing, symptomatic scar - and the features that mean it’s time to escalate.

  • Raised, firm plaque

    Rubbery or fibrous nodule that sits proud of the surrounding skin and feels tethered on palpation.

  • Growth beyond the wound

    The defining feature - the scar extends past the original injury with claw-like or dumbbell projections.

  • Colour and vascularity

    Pink, red, purple or hyperpigmented - often more vivid in the first year and duskier as it matures.

  • Itch, pain and tenderness

    Common and under-recognised - itch can be constant and pain is often triggered by clothing or pressure.

  • High-risk sites

    Earlobes, chest wall, shoulders, upper back and jawline - keloids favour high-tension and sebaceous zones.

  • After piercings and acne

    Ear-piercing keloids and post-acne keloids on the chest and back are two of the commonest presentations.

  • Spontaneous keloids

    Some appear without any recognised injury, particularly on the pre-sternal chest - a strong genetic signal.

  • Red flag - functional restriction

    A keloid crossing a joint or the neck can restrict movement and needs early specialist review, not watchful waiting.

Treatment

How keloid scars are treated in the UK.

Silicone first, then intralesional steroid with 5-FU, cryotherapy and laser - with surgery plus adjuvant radiotherapy or pressure for resistant scars.

  • Silicone gel or sheeting

    First-line for new and early scars - worn 12 to 23 hours a day for at least 3 months. Safe in pregnancy and in children.

  • Intralesional triamcinolone

    Injected steroid every 4 to 6 weeks - flattens, softens and eases itch. The most widely used office treatment for keloids.

  • Intralesional 5-fluorouracil

    Often combined with triamcinolone - reduces steroid side effects and improves response in stubborn, thick keloids.

  • Cryotherapy

    Contact or intralesional freezing - best for small, young keloids. Some pigment loss is common in darker skin.

  • Pulsed dye laser (PDL)

    Targets the vascular red component - reduces redness, itch and pliability. Well tolerated in most skin types with careful settings.

  • Nd:YAG laser

    Longer-wavelength laser used for thicker, deeper keloids and in darker skin - lower risk of pigmentary change than PDL alone.

  • Surgical excision with adjuvant

    Excision only ever combined with an adjuvant (intralesional steroid, radiotherapy or pressure) - alone it recurs in most patients.

  • Adjuvant radiotherapy

    Low-dose radiotherapy within 24 to 48 hours of excision - reserves for stubborn, high-risk keloids under specialist oncology care.

  • Pressure garments and clips

    Compression 12 to 23 hours a day for at least 6 months - the mainstay for earlobe keloids after excision and burn-related scars.

What this guide is based on

The sources behind every claim on this page.

UK dermatology guidance, international scar-management consensus and specialist oncology standards, 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 and history and can tell you which parts apply to you. If in doubt, get seen.

  • British Association of Dermatologists (BAD). Patient information and guidance on keloid and hypertrophic scars.

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

  • European Society for Radiotherapy and Oncology (ESTRO). Guidance on post-excision keloid radiotherapy.

  • Cochrane Reviews. Silicone gel sheeting and intralesional therapies for hypertrophic and keloid scars.

Red flags

When keloid scars need urgent attention.

Most keloids are managed as outpatient cases. These are the situations that need a specialist opinion sooner rather than later.

  • Functional restriction

    A keloid limiting neck, shoulder or hand movement needs specialist review - waiting rarely improves it and can make surgery harder.

  • Rapid growth or ulceration

    Sudden change in size, breakdown of the surface or bleeding is not typical of a stable keloid - a biopsy may be needed to exclude other diagnoses.

  • Suspected dermatofibrosarcoma

    A firm, expanding plaque that behaves like a keloid but keeps growing can be dermatofibrosarcoma protuberans - specialist referral is essential.

  • Severe itch, pain or sleep disturbance

    Symptomatic keloids affect daily life more than their size suggests - a clear indication to treat, not just monitor.

  • Psychological distress

    Visible keloids on the face, ears, chest and hands carry a real mental-health burden - dermatology plus psychology support helps.

  • Post-burn contracture

    Burn-related hypertrophic scars crossing joints can restrict movement - early pressure garments and plastic-surgery input matter.

  • Recurrent keloid after surgery

    Recurrence after excision is a clear signal that any next attempt must include an adjuvant plan - not another isolated excision.

  • Steroid injection atrophy

    Skin thinning, hypopigmentation or telangiectasia around injected keloids - a prompt to adjust dose or add 5-FU.

  • Radiotherapy considerations

    Adjuvant radiotherapy is very effective but requires careful case selection - particularly in young patients and near the thyroid or breast.

Living with it

A treatable condition, with a clear ladder.

Four things that make the biggest difference day to day - protecting fresh wounds, being patient with topical and injection therapy, being cautious with piercings, and treating symptoms early.

A quiet reminder

Consistency beats intensity, every time.

Silicone and pressure only work if they’re worn. A modest routine kept up for months does more than a heroic week of anything.

  1. 01 Prevent

    Protect early wounds

    Silicone, gentle tension relief and sun protection in the first 6 to 12 months after any wound or surgery - especially if you have a personal or family history of keloids.

  2. 02 Patience

    Think in months, not weeks

    Injections, silicone and laser all work over months. Judge progress at 3 and 6 months, not after one session.

  3. 03 Piercing

    Be cautious with piercings

    If you keloid, avoid ear cartilage and repeated piercings on high-risk sites - and consider silicone or pressure clips at the first sign of a raised scar.

  4. 04 Escalate

    Don’t settle for symptoms

    Itch, pain and restriction are real reasons to treat - even scars that look "cosmetic" can cause daily discomfort.

Frequently asked

Everything we get asked about keloid scars.

Quick answers on silicone, injections, laser, surgery and radiotherapy.

  • What is a keloid scar?

    A benign but overactive scar that grows beyond the borders of the original wound. Unlike a hypertrophic scar, which stays within the wound and often settles over time, a keloid rarely regresses without treatment and can carry on enlarging for years.

  • Why do some people get keloids and others don’t?

    There is a strong genetic component - risk is much higher in Fitzpatrick skin types IV to VI and in people with a family history of keloid scarring. Local factors like wound tension, infection and delayed healing add to the risk. Common triggers include ear piercings, acne on the chest and back, surgical scars and burns.

  • How is a keloid different from a hypertrophic scar?

    A hypertrophic scar is raised but stays within the boundaries of the original wound and usually flattens over 12 to 18 months. A keloid extends beyond the wound, keeps growing, and often causes itch and pain. The distinction matters because treatment intensity and expectations differ.

  • What is the first-line treatment?

    For new or early scars, medical-grade silicone gel or sheeting worn for most of the day for at least three months is the best-evidenced conservative option. For established keloids, intralesional triamcinolone - often combined with 5-fluorouracil - every 4 to 6 weeks is standard first-line treatment.

  • Can a keloid be surgically removed?

    Yes, but only as part of a combined plan. Excision on its own recurs in most patients - sometimes larger than before. Reliable results come from excision combined with an adjuvant such as intralesional steroid, low-dose radiotherapy within 48 hours of surgery, or long-term pressure garments and clips, particularly for earlobe keloids.

  • Is radiotherapy for keloids safe?

    Post-excision radiotherapy uses very low doses delivered within a day or two of surgery and is one of the most effective ways to prevent recurrence in high-risk keloids. It is used selectively - typically avoided in children and near sensitive structures like the thyroid or breast - and is planned and delivered by a clinical oncologist as part of a multidisciplinary keloid pathway.

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