If you have a raised scar, you have probably heard it called a keloid. In everyday use that word covers almost any scar that sits above the skin. In the clinic the word is narrower. A keloid and a hypertrophic scar are two diagnoses, and one rule separates them. They behave differently, and they are treated differently. Here is how to tell them apart.
A keloid grows past the wound edge
It comes down to where the scar stops. A hypertrophic scar thickens but stays within the original wound. A keloid does not. It spreads beyond the wound into normal skin (Ogawa 2017, PMID 28287424). A familiar example is an earlobe piercing that grows into a lump far bigger than the hole.
A keloid does not settle on its own
The other difference shows up over time. A hypertrophic scar tends to flatten, at least in part, over months to years. A keloid rarely shrinks. It stays as it is, or it keeps growing.
Where the treatment changes
Treatment starts the same way for both. Once the wound has closed, start with tape to keep tension off the scar. Silicone gel or sheets come next (Monstrey 2014, PMID 24888226).
A keloid needs more than that. We combine several treatments and keep them going for longer than most people expect. The two are not always easy to tell apart by eye. If a scar has spread beyond the wound it came from, have it looked at. The same goes for one that has not settled after a long time.
So when a raised scar comes in, the first thing we check is whether it stayed inside the wound.
References
- Ogawa R (2017). Keloid and hypertrophic scars are the result of chronic inflammation in the reticular dermis. Int J Mol Sci. PMID 28287424 (opens in new window).
- Monstrey S, et al. (2014). Updated scar management practical guidelines: non-invasive and invasive measures. J Plast Reconstr Aesthet Surg. PMID 24888226 (opens in new window).
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