Keloid vs Hypertrophic Scar: What Is the Difference?
By Dr. Sushrut Tated, plastic surgeon
Keloid vs hypertrophic scar comes down to borders and behaviour. A hypertrophic scar is raised but stays within the original wound and often flattens over a year or two. A keloid grows beyond the wound into normal skin, rarely settles on its own and often returns after surgery alone. Both respond to silicone and steroid injections. See keloid treatment.
Dr. Sushrut explains keloid treatment
What are hypertrophic scars and keloids?
Both are raised scars caused by the skin making too much collagen while healing. They can follow surgery, cuts, burns, acne, piercings, vaccinations or tattoos. The key difference is how they behave over time.
Keloid vs hypertrophic scar at a glance
| Hypertrophic scar | Keloid | |
|---|---|---|
| Borders | Stays within the original wound | Spreads beyond the wound into normal skin |
| When it appears | Within weeks of the injury | Weeks to months after, sometimes later |
| Course | Often flattens over 1-2 years | Rarely settles; may keep growing |
| Common sites | Anywhere, especially across joints and after burns | Chest, shoulders, upper back, ear lobes, jawline |
| Symptoms | Itch, tightness, redness | Itch, pain, tenderness, sometimes more marked |
| After surgery alone | Can improve with careful revision | Recurrence is common |
| Family tendency | Less marked | Often runs in families |
Why does the difference matter?
The difference changes treatment. A hypertrophic scar may simply need time, silicone and massage, or a surgical revision if it is wide or tight. A keloid needs a cautious plan, because cutting it out alone often leads to regrowth. Reported recurrence after excision alone for keloids ranges from about half to nearly all cases.
How are hypertrophic scars treated?
- Silicone gel or sheets, the usual first step.
- Massage and pressure, especially after burns.
- Steroid injections for thick or itchy areas.
- Laser to improve redness and texture.
- Surgical revision, including Z-plasty, for wide or tight scars once they have matured; see scar revision surgery.
How are keloids treated?
- Steroid injections, usually the first step, repeated every few weeks.
- Silicone and pressure, such as pressure earrings for ear lobe keloids.
- Cryotherapy or other injected medicines for stubborn keloids.
- Surgery combined with follow-up treatment, such as steroid injections, pressure or radiotherapy.
- Prevention: avoiding unnecessary piercings, tattoos and cosmetic procedures.
International scar guidelines recommend combining treatments and treating keloids actively from the start.
How can you lower the risk of a raised scar after surgery?
- Tell your surgeon if you or your family form keloids or thick scars.
- Stop smoking and keep blood sugar well controlled to help healing.
- Keep the wound clean and avoid stretching it in the first weeks.
- Start silicone gel or sheets once the wound has healed, if advised.
- Protect the scar from the sun for at least a year.
- Report early thickening, itching or redness, which is easier to treat early with injections.
Treatments compared
| Treatment | Hypertrophic scar | Keloid |
|---|---|---|
| Silicone gel or sheets | First step; often effective | Helpful, usually with other treatment |
| Steroid injections | For thick or itchy areas | Usually the first step |
| Pressure | Useful, especially after burns | Useful, such as pressure earrings |
| Laser | Improves redness and texture | Adjunct to other treatment |
| Surgery | For wide or tight scars once mature | Only with follow-up treatment |
Myths about raised scars
- “All raised scars are keloids.” Many are hypertrophic scars that settle with time.
- “Keloids can be cut out for good.” Surgery alone often leads to regrowth.
- “Home remedies dissolve keloids.” There is no good evidence for this.
- “Keloids are a sign of poor hygiene.” They depend on skin type and genetics, not hygiene.
When should you see a doctor?
See a doctor if a raised scar is growing beyond its wound, itching or painful, limiting movement, or if you are planning surgery and know you form keloids. Any scar that changes suddenly, bleeds or forms a non-healing sore should be checked.
What should you ask?
- Is my scar a keloid or a hypertrophic scar?
- What treatment would you start with, and how many sessions?
- Would surgery help, and what would follow it?
- How can I lower the risk of new keloids?
For treatment details and cost factors, see keloid treatment. For other scar options, read scar revision surgery or laser.
Frequently asked questions
Can a hypertrophic scar turn into a keloid?
They are different scar types, though early on they can look similar. A scar that keeps growing beyond the wound edges is behaving like a keloid and should be assessed.
Do hypertrophic scars go away on their own?
They often flatten and fade over one to two years, especially with silicone, massage and pressure. Treatment can speed this up.
Why do keloids come back after surgery?
Cutting a keloid creates a new wound in skin that tends to overheal. Without follow-up treatment such as steroid injections, pressure or radiotherapy, keloids often regrow, sometimes larger.
Who is more likely to get keloids?
People with darker skin, those with a family history, people between their teens and about 30, and wounds on the chest, shoulders, upper back, ear lobes and jawline.
Are keloids dangerous?
No. Keloids are benign. They can itch, hurt, limit movement or affect confidence, which are good reasons to treat them.
Can I get a piercing or tattoo if I form keloids?
It is safer to avoid them, especially on the ear lobes, chest and shoulders, because they can trigger new keloids.
References
- Keloid (StatPearls). NCBI Bookshelf, StatPearls Publishing.
- Keloid scars. NHS.
- Updated international clinical recommendations on scar management: part 2, algorithms for scar prevention and treatment. Gold MH et al., Dermatologic Surgery, 2014.
- Updated scar management practical guidelines: non-invasive and invasive measures. Monstrey S et al., Journal of Plastic, Reconstructive & Aesthetic Surgery, 2014.
