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Keloids and raised scars

Clinical name: keloids and hypertrophic scars

Some scars grow thick and raised, and a few spread past the original wound. Here's who is reported more affected, what can trigger them, and when to get help.

Education, not a diagnosis. Only a clinician who examines your skin can say what you have. Every point below shows how strong the evidence is and links to its source.

Who it affects

  • People of every background can get keloids. They are reported more often in people with deeper skin tones, and anyone can be affected.[1,2,3]Supported
  • The highest reported risk is in people of Black African descent. Raised risk is also reported in people of South Asian, Chinese and other Asian, Latin American and Mediterranean descent.[1,4]Supported
  • Keloids often run in families. Having had a keloid before is also a reported risk marker.[1,4]Supported
  • They are reported more often between the ages of 10 and 30, and during pregnancy.[4]Supported
  • Your own scar history, and your family's, tells you more than your heritage does. Heritage alone can't predict what your skin will do.[1,5]Mechanistic only

What it can look like

  • A raised scar that stays within the edges of the wound (a hypertrophic scar) often flattens and improves with time.[1,6]Supported
  • A keloid grows beyond the edges of the original wound. Keloids don't fade on their own.[1]Supported
  • A keloid can appear months or even years after the injury that started it.[2,4]Supported
  • Reported triggers include ear and body piercings, tattoos, surgery, acne, burns, insect bites and vaccinations.[2,4,7]Supported
  • Razor bumps and bumps at the back of the neck after close haircuts can also lead to raised, keloid-like scarring.[8,9,10]Thin
  • Hair removal by electrolysis has been linked to keloids in people with darker skin.[11]Mechanistic only

What helps

Know your own scar history

This is the most useful thing you can bring to any appointment.

  • Think about whether you, or close family, have ever had a scar that grew bigger than the wound. That history is what doctors ask about.[1,4]Mechanistic only
  • Tell any clinician about past raised scars before a procedure, even a small one.[4,7]Mechanistic only

Before piercings, tattoos or elective procedures

  • People who already form raised scars are advised to avoid elective piercings and tattoos, or to talk with a dermatologist first.[4,7]Mechanistic only
  • The same conversation is worth having before electrolysis, laser treatments or having bumps removed.[11,12]Mechanistic only
  • No one can promise a procedure won't cause a keloid. A dermatologist can help you weigh it.[4]Mechanistic only

Lower the triggers you can

These may lower the chances. They are not a guarantee.

  • Treating acne early is recommended, partly to lower the chance of scarring.[4,13]Mechanistic only
  • Getting help with razor bumps before they scar matters for the same reason.[9,14]Mechanistic only
  • Keloids can't be reliably prevented. If one forms despite your care, that isn't your fault.[4]Mechanistic only

What treatment can involve

A dermatologist chooses with you. This is only so the words are familiar before you go.

  • Steroid injections into the scar are common. Many keloids shrink, but many grow back over the following years.[7]Supported
  • Surgery is usually combined with other treatments. Surgery alone often leads to the keloid coming back, sometimes larger.[2,7]Supported
  • Freezing (cryotherapy) can leave permanent light spots on darker skin.[7]Supported
  • Other options include laser, pressure earrings or garments, and radiation, which has its own risks to discuss.[2,7]Supported
  • Early treatment may help stop a keloid from growing.[4]Mechanistic only

Silicone sheets: what the evidence says

  • Silicone gel sheets are widely suggested in patient information.[7]Mechanistic only
  • A Cochrane review found only weak evidence that they prevent raised scars in people at high risk. Whether they help existing scars is uncertain.[6]Thin
  • The trials were poor quality, the review is from 2013, and it did not look at results by skin tone.[6]Thin

What to avoid

  • Trying to cut, tie off or freeze a raised scar yourself. Even when doctors remove keloids, surgery alone often brings them back, sometimes larger.[2,7]Supported
  • Waiting for a keloid to fade by itself. Keloids don't go away on their own.[1]Supported
  • New ear piercings if you already form keloids, without talking to a dermatologist first.[4,7]Mechanistic only
  • Leaving acne untreated if you know you form raised scars.[4,13]Mechanistic only
  • Relying on any product sold as keloid prevention. Keloids can't be reliably prevented, and the evidence for silicone is weak.[4,6]Thin
  • Assuming your heritage decides your risk, or rules it out. Anyone can form a keloid.[1,5]Mechanistic only

When to see a clinician

  • A scar that keeps growing, itches or hurts.[1,4]Mechanistic only
  • A scar that limits how a joint moves.[4]Mechanistic only
  • A raised scar that appears after a small injury, such as a scratch, spot or bite.[4]Mechanistic only
  • Before any piercing, tattoo or elective procedure, if you or your family form raised scars.[4,7]Mechanistic only
  • Bumps at the back of the neck or scalp that are thickening or leaving scars. Early care matters there.[10]Supported

Questions to ask a provider

  • Does this look like a keloid or a raised scar that may flatten on its own?
  • Which treatments do you suggest, and how often does the scar come back after each?
  • Could this treatment leave light or dark marks on my skin tone?
  • If surgery is an option, what else would you combine it with to lower the chance of regrowth?
  • I form raised scars. What should I think about before a piercing, tattoo or procedure?

Label claims to question

“Prevents keloids”
Keloids can't be reliably prevented. A product can't promise this, and the best-studied option, silicone sheeting, has only weak evidence.[4,6]
“Scar-fading”
Hypertrophic scars often improve with time anyway, and keloids don't fade on their own. Ask what kind of scar the claim was tested on, and in whom.[1,6]
“Keloid-free piercing aftercare”
Aftercare can't change how your skin forms scars. People who form keloids are advised to talk with a dermatologist before piercing.[4,7]

Where the evidence is thin

  • Figures for how common keloids are in different groups vary widely, and the original population studies were not reviewed here. No one can predict an individual's risk from heritage.
  • The main review of silicone sheets is from 2013, the trials were poor quality, and none reported results by skin tone.
  • The NHS keloid page used here was past its scheduled review date when it was read.

Keep going

Sources

Retrieved and read for this guide; reviewed 2026-09-13. A source listed here says what it establishes and what it does not — a citation is not an endorsement.

  1. [1]Keloids: Overview · American Academy of Dermatology, 2022Establishes: People of all races get keloids. Black people are reported to have the greatest risk, and people of Asian, Latin American or Mediterranean descent are also at raised risk. Family history is present in about a third to a half of cases. Keloids do not fade by themselves.Does not establish: Individual risk, or piercing-specific prevention (that is on the treatment page).
  2. [2]Keloids and hypertrophic scars · DermNet (Yoong, Numan; reviewed Coulson), 2022Establishes: Keloids are more frequent in Fitzpatrick III–VI. Listed triggers include trauma, burns, surgery, acne, insect bites and immunisation. Lists treatments and warns that excision can produce a larger keloid.Does not establish: Anything about piercings or tattoos, or risk figures by ancestry beyond one self-report figure.
  3. [3]Common Dermatologic Conditions in Skin of Color · Frazier WT, Proddutur S, Swope K. Am Fam Physician 2023;107(1):26-34. American Academy of Family Physicians, 2023Establishes: Clinical review with SORT ratings. Reported prevalence: DPN about 33% in skin of color, PFB 45–83% in affected groups, and keloids higher in types III–VI than I–II. Recommendations with SORT grades: stopping shaving for at least 8 weeks for PFB (SORT C); avoiding close shaves and tight collars or helmets for AKN; laser for AKN (SORT B). Notes erythema looks different on darker skin.Does not establish: The primary prevalence studies, which were not retrieved. One PIH percentage in the fetched page looked garbled and is not used.
  4. [4]Keloid scars · NHS (UK), 2023Establishes: Higher likelihood is listed for South Asian, Chinese, African Caribbean or Black African descent, age 10–30, pregnancy and prior keloids. If at higher risk, avoid tattoos and piercings. Early acne treatment reduces scarring. Keloids cannot be prevented outright.Does not establish: Numeric risk.
  5. [5]International Expert Consensus on Defining Skin of Color and Delivering Equitable Dermatologic Care · Lim HW et al. Int J Dermatol (PMC lists 2025; publisher lists 2026). PMID 41195697. Wiley / PMC, 2025Establishes: Literature review plus international expert panel. 'Skin of color' is acceptable but imperfect. Alternatives such as 'melanin-rich skin' were proposed. 'Ethnic skin' is rejected as imprecise, and national descriptors are preferred in parts of Asia. Fitzpatrick is practical but designed for fair skin. Do not use race alone as a proxy; combine skin tone with self-identification.Does not establish: A universally adopted standard — it acknowledges ongoing debate.
  6. [6]Silicone gel sheeting for preventing and treating hypertrophic and keloid scars · Cochrane (O'Brien L, Jones DJ), 2013Establishes: 20 trials with 873 people. There is only weak evidence that silicone sheeting prevents abnormal scarring in high-risk people, and treatment benefits are uncertain because the trials are poor quality and at high risk of bias.Does not establish: Effectiveness by skin tone (no subgroup analysis). It is not current (2013).
  7. [7]Keloids: Treatment · American Academy of Dermatology, 2023Establishes: Describes steroid injections (many shrink, many regrow within 5 years), surgery combined with other treatments (surgery alone usually recurs), cryotherapy (can leave permanent light spots on darker skin), laser, silicone sheets, pressure earrings and radiation. Advises keloid-prone people to avoid ear piercing and other skin trauma.Does not establish: Comparative effectiveness, or which treatment suits an individual.
  8. [8]Pseudofolliculitis barbae; current treatment options · Ogunbiyi A. Clin Cosmet Investig Dermatol 2019. PMID 31354326. Dove Medical Press / PMC, 2019Establishes: PFB is more frequent with tightly curled hair (men of African and, less often, Asian descent), and is also reported in women with hirsutism. Lists risky techniques (dry shaving, against the grain, stretching, multi-blade pull), clippers with a guard, and depilatory irritation. Laser (Nd:YAG 1064 nm among others) for darker skin, usually 3–7 sessions. Topical glycolic acid, benzoyl peroxide/clindamycin, retinoids and eflornithine. Keloids can follow PFB.Does not establish: Systematic evidence — it is a narrative review, and much of what it cites is small or observational.
  9. [9]Pseudofolliculitis barbae · DermNet (Numan, Gomez, Oakley), 2022Establishes: PFB occurs in all races but predominantly in men of African ancestry (about 45–80%). Mechanism: sharp hair tips re-enter the skin. Complications are PIH, keloids and infection. Covers shaving technique, depilatories, Nd:YAG laser, and topical glycolic acid, retinoids, benzoyl peroxide and eflornithine.Does not establish: The strength of evidence for each measure, or women in any depth.
  10. [10]Folliculitis keloidalis (acne keloidalis nuchae) · DermNet (Ng; peer review Wales, Whittaker), 2024Establishes: Mostly affects men of African-Caribbean descent with textured hair, and is about 20 times more common in men. Triggers are very short haircuts, close shaving, and friction from headgear or collars. It can scar and cause permanent hair loss. Early care matters; treatments escalate to injections, isotretinoin, surgery or laser.Does not establish: Prevalence in women or in groups not of African descent, in any detail.
  11. [11]6 ways to remove unwanted hair · American Academy of Dermatology, 2023Establishes: All skin tones can have laser hair removal if the operator is experienced with that skin tone. Patch-test depilatories. Warns that people with darker skin can develop keloids after electrolysis.Does not establish: How often complications occur.
  12. [12]Dermatosis papulosa nigra · DermNet, 2008Establishes: DPN predominantly affects darker skin (types IV–VI), with up to 35% reported in Black Americans, more often women, and onset in adolescence. The papules are benign and resemble small seborrhoeic keratoses. Destructive treatments can cause pigment change, scarring and keloids, so they are generally best left untreated.Does not establish: Any help identifying a new or changing spot. Old page (2008).
  13. [13]10 tips for clearing acne in darker skin tones · American Academy of Dermatology, 2026Establishes: Advises treating acne and dark spots together and early, to lower the chance of keloids and dark spots, and starting benzoyl peroxide at a low strength (2.5%) to limit irritation. Suggests swapping oil-based hair products for water- or glycerin-based ones if acne is on the forehead or temples ('pomade acne'), and using non-comedogenic products and gentle care. Says to avoid scrubbing and picking, and to see a dermatologist before peels, microdermabrasion or lasers, which can leave lasting light or dark spots in darker skin without expertise.Does not establish: How often these complications happen, or trial evidence for the tips. It does not address isotretinoin.
  14. [14]6 razor bump prevention tips from dermatologists · American Academy of Dermatology, 2022Establishes: Anyone can get razor bumps. Tips: stopping shaving, shaving with the grain after softening the hair, replacing blades, shaving frequently. Untreated bumps can leave grooves and raised scars; see a dermatologist if they persist.Does not establish: Trial evidence for each tip.
Near-black ground, following the device