A keloid grows past the edge of the wound that caused it. A hypertrophic scar does not. That single boundary decides almost everything that follows.
Both a keloid and a hypertrophic scar are raised. Both can itch, ache and feel tight. To most people they look like the same problem.
They are not, and the difference is visible at the edge.
A hypertrophic scar stays within the margins of the original wound. It is raised, but it respects the outline of the injury that produced it, and over months to a couple of years it commonly flattens and softens without intervention.
A keloid does not respect that outline. It extends outward into skin that was never injured, and it characteristically does not regress on its own. A small piercing can produce a lesion many times the size of the original hole.
“A keloid grows past the edge of the wound that caused it. A hypertrophic scar does not. That single boundary decides almost everything that follows.”
Dr Sin YongOn distinguishing the two
Normal wound healing has a remodelling phase. Collagen laid down during repair is gradually reorganised and the scar settles back toward the level of the surrounding skin.
In a keloid, that phase does not conclude. Deposition of type I and type III collagen continues well past the point where healing should have finished, and the lesion expands rather than resolving.
Genetic susceptibility is a major factor, which is why keloids frequently run in families — and why a family history is worth mentioning at consultation even if you have never formed one yourself.
Keloid formation is substantially more common in people of Chinese, Malay, Indian and African descent than in those with white European skin.
In Singapore's population this makes keloid a routine presentation rather than an unusual one — and it is why keloid history is asked about before any procedure that breaks the skin, including treatments elsewhere on this site.
Common sites follow skin tension: earlobes after piercing, the upper chest, the shoulders, the upper back and along the jawline. Keloids also arise on surgical scars, burns and acne lesions — which is where this overlaps with acne scar treatment, though the two are managed differently.
It is the first thing most people ask, and it deserves a direct answer.
Excision alone carries a high recurrence rate, and a recurrent keloid is frequently larger than the one that was removed — because the excision itself is a fresh wound in skin already prone to abnormal healing.
Where surgery has a role at all, it is combined with adjuvant treatment rather than performed on its own. Anyone offering straightforward removal without discussing what follows it is not describing the problem accurately.
Intralesional corticosteroid is first-line, frequently in combination with fluorouracil. These are prescription medicines requiring assessment, monitoring and a discussion of side effects before any course begins.
Adjuncts are selected by site, by how old the lesion is, and by how it has responded to anything tried previously: pressure therapy, silicone, cryotherapy, and laser directed at the vascular and textural components.
Plans are usually combined rather than single-modality, and they are staged over time rather than completed in one visit.
Keloids have a genuine tendency to recur. Any honest conversation includes that from the beginning rather than after.
Treatment is directed at flattening, softening and controlling symptoms — the itch, the tenderness, the tightness across a joint or the neck. For many patients those symptoms, not the appearance, are what brings them in.
Ongoing review is frequently part of the plan. What is realistic in your case is discussed at assessment.
Response varies with the size, site and age of the lesion, skin type, genetic factors and previous treatment. Not every keloid is suitable for every approach, and suitability is assessed in person.
Keloids vary widely between patients, so cost follows the plan rather than a fixed list. Four things shape it:
A figure quoted before assessment would not reflect your presentation. Cost is set out clearly at consultation, before anything is agreed.
A keloid extends beyond the boundary of the original wound into surrounding normal skin. A hypertrophic scar is raised but stays within the original wound margins. Hypertrophic scars often flatten over months to a couple of years; keloids characteristically do not regress on their own. The distinction is made on examination and it decides the approach, because the two behave differently.
A keloid represents an abnormal, prolonged wound-healing response with excess deposition of type I and type III collagen. Rather than the normal remodelling phase bringing the scar back toward the skin surface, collagen production continues and the lesion expands. Genetic susceptibility is a major factor, which is why keloids often run in families.
Yes. Keloids are substantially more common in individuals of Chinese, Malay, Indian and African descent than in those with white European skin. In Singapore's population this is a common presentation, and it is one reason keloid history is asked about before any procedure that breaks the skin.
Earlobes after piercing, the upper chest, the shoulders, the upper back and along the jawline. These are sites of relatively high skin tension. Keloids also form on surgical scars, burns, acne lesions and sometimes at vaccination sites.
Excision alone has a high recurrence rate, and a recurrent keloid is frequently larger than the original. Surgery, where it is appropriate at all, is combined with adjuvant treatment rather than performed on its own. This is one of the more important things to understand before agreeing to removal.
Intralesional corticosteroid injection is first-line, often in combination with fluorouracil. These are prescription medicines requiring assessment and monitoring. Pressure therapy, silicone, cryotherapy and laser are used as adjuncts depending on the site, the age of the lesion and how it has responded previously. Plans are usually combined rather than single-modality.
Keloids have a genuine tendency to recur, and any honest discussion includes that. Treatment aims at flattening, softening and symptom control rather than guaranteed permanent removal. Ongoing review is often part of the plan, and that is discussed openly at consultation rather than after.
Frequently. Itch, tenderness, a burning or stinging sensation, and restriction of movement where a keloid crosses a joint or the neck. For many patients the symptoms rather than the appearance are the reason they seek assessment.
A personal or family history of keloid formation is relevant to any procedure that breaks the skin, and it is asked about before treatment here. It does not rule everything out, but it changes what is advisable and how a procedure is planned.
Cost depends on the size and number of lesions, the site, which modalities the assessment indicates, and how the plan is staged over time. Because keloids vary so widely between patients, a figure quoted before assessment would not be meaningful. Cost is set out clearly at consultation.
Keloid — StatPearls. National Center for Biotechnology Information. source
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