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Skin & hair

How to Get Rid of a Keloid Scar: What Actually Works

A keloid is a raised scar that grows beyond the original wound and will not resolve on its own — no home remedy reliably removes one. Dermatologists can flatten and soften most keloids with corticosteroid injections, combination therapy, or surgery paired with radiation, though keloids tend to recur. Starting treatment early gives better results.

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What Is a Keloid, and How Is It Different From a Hypertrophic Scar?

Normal wound healing ends with scar tissue that stays within the original wound margins and gradually softens. In keloid-prone individuals, collagen-producing fibroblasts keep working past the wound boundary — and do not stop 1. The result is a firm, smooth, dome-shaped or claw-like scar that expands beyond the original injury, can be skin-colored, pink, red, or darker than surrounding skin, and continues to grow over months to years.

The key distinction from a hypertrophic scar: a hypertrophic scar stays within the wound's original footprint and frequently flattens on its own over one to two years without treatment. A keloid does not observe that boundary and does not self-resolve. Distinguishing the two matters clinically because management differs.

Keloids are significantly more common in people with darker skin tones (Fitzpatrick types IV–VI), as well as in those of African, Hispanic, and Asian descent, with prevalence estimates ranging from roughly 5 to 16 percent in those populations compared with lower rates in lighter-skinned individuals 2. A strong family history is one of the most reliable predictors that a raised scar is a true keloid and that it will recur after treatment 2. Keloids form most often after ear piercings, surgical incisions, acne, burns, and chickenpox, and they appear most frequently in people between puberty and middle adulthood.

What Does a Dermatologist Do First: Corticosteroid Injections

Intralesional corticosteroid injection — most commonly triamcinolone acetonide — is the most widely used first-line treatment 13. The medication reduces local inflammation and suppresses fibroblast activity, progressively flattening and softening the keloid over a series of injections spaced several weeks apart.

Results vary considerably. Some keloids flatten significantly; others achieve only partial improvement. Possible side effects include skin thinning (atrophy), widening of small surface blood vessels (telangiectasia), and localized skin lightening — side effects that are reversible in most cases but carry particular relevance for people with darker skin tones, who may notice visible pigment changes at the injection site 4. Multiple sessions are typical, and the keloid may eventually regrow if no additional treatment follows.

Because monotherapy with corticosteroids has variable and sometimes incomplete results, dermatologists increasingly combine it with other agents from the start.

Why Combination Therapy Works Better Than a Single Treatment

The evidence consistently shows that combining treatments produces more durable outcomes than any single approach 1. Common pairings include:

Corticosteroid + intralesional 5-fluorouracil (5-FU). Intralesional 5-FU is an antimetabolite that interrupts collagen synthesis through a different pathway than corticosteroids. A randomized controlled trial comparing the two agents found similar keloid remission rates at six months, but significantly less skin atrophy and telangiectasia with 5-FU (8 percent atrophy versus 44 percent with triamcinolone alone) 5. Combining both agents tends to outperform either alone, with larger reductions in scar volume and lower recurrence 1.

Silicone gel sheeting. Applied consistently over several months, silicone sheets or silicone gel can soften and flatten scars — with stronger evidence for prevention of hypertrophic scars and as an adjunct in keloid management than as a standalone keloid cure 1. They are safe for long-term use and are a reasonable starting point for smaller or early keloids while awaiting a specialist appointment.

Cryotherapy (freezing). Surface cryotherapy can reduce keloid bulk and is sometimes combined with corticosteroid injection. Evidence for intralesional cryotherapy — freezing from within the scar using a probe — is mixed; one controlled trial was halted early because results were inferior to excision plus corticosteroid injection 1.

Pressure therapy. Compression garments or pressure earrings (for ear keloids) reduce blood flow to the scar and are used primarily to prevent recurrence after other treatments, particularly for ear piercing keloids. Evidence for pressure as standalone therapy is limited 1.

Does Surgery Work for Keloids?

Surgery alone for keloids is a well-established problem: cutting through a keloid can stimulate a new — sometimes larger — keloid at the surgical site. Reported recurrence rates after excision without any adjuvant treatment approach 100 percent in some series 6.

Because of this, surgical excision for keloids is almost always combined with a second modality immediately or shortly after. The two most evidence-supported pairings are:

Excision plus post-operative corticosteroid injections. Injecting the healing scar site after surgery reduces recurrence substantially compared with excision alone. One systematic review and meta-analysis found that post-operative steroid injection produced significantly lower recurrence than intraoperative injection 7.

Excision plus radiation therapy. Delivering radiation to the excision site — typically starting within 24 hours of surgery — is among the most effective strategies for preventing recurrence in persistent or large keloids. Recurrence rates in the range of 3 to 10 percent have been reported in studies using fractionated protocols of 12–18 Gy over several days 1. The use of radiation is generally reserved for keloids that have failed other approaches, given the general principle of limiting cumulative radiation exposure.

Other Treatments a Dermatologist May Consider

The field has a growing range of adjunct options, particularly for keloids that have not responded to first-line approaches:

  • Laser therapy can reduce redness, surface texture, and sometimes thickness. Choosing the right device for melanin-rich skin requires clinical experience — the same principles that govern any laser use on darker skin tones apply here.
  • Intralesional bleomycin is another antifibrotic agent that may be used when standard options have been insufficient.
  • Platelet-rich plasma (PRP) has been combined with excision and other treatments in some protocols with reported benefit, though the evidence base is still developing.
  • Verapamil (intralesional) is an occasional adjunct, though results are mixed in the literature 1.

Emerging systemic and biologic therapies are under active investigation, particularly for severe or recalcitrant keloids, though none are currently part of routine dermatology practice.

Prevention: More Reliable Than Treatment

For individuals with a known keloid tendency, preventing the next one is more reliably effective than treating an established one. Practical steps include:

  • Applying silicone sheeting or gel early on any new wound or surgical incision, starting once the wound is closed and continuing for several months.
  • Using pressure therapy on healing ear piercings or other high-risk sites.
  • Keeping wounds clean and minimizing prolonged inflammation — infection and slow healing increase keloid risk.
  • Discussing keloid history with any surgeon or clinician before elective skin procedures. For people with strong personal or family history, avoiding non-essential piercings and elective skin procedures is a medically reasonable choice.
  • Seeking early treatment for any emerging raised scar — treatment at the early, smaller stage consistently yields better outcomes than waiting years.

What Factors Shape Treatment Choice?

A dermatologist's treatment plan for a specific keloid takes into account several factors that vary from person to person:

  • Location. High-tension areas — shoulders, chest, back — are more prone to keloid recurrence. Ear keloids, by contrast, tend to respond well to combined excision and steroid injection, with lower recurrence than trunk keloids.
  • Skin tone. Corticosteroid-related skin lightening and laser device selection require careful consideration in patients with Fitzpatrick types IV–VI.
  • Size and age of the keloid. Smaller, newer keloids generally respond better. Older, larger keloids may require excision plus radiation to achieve meaningful improvement.
  • Prior treatment history. A keloid that has already recurred after one approach may need a different or escalated plan.
  • Personal and family history. Strong keloid tendency predicts a higher recurrence risk after any treatment — which influences how aggressively to combine modalities from the outset.

Common questions

Can a keloid go away on its own without treatment?

Keloids do not resolve on their own and do not shrink over time the way hypertrophic scars often do. Without treatment, most continue to grow, some slowly and some more rapidly. Early intervention gives better results than waiting.

Will a keloid come back after treatment?

Recurrence is a real risk with every keloid treatment, which is why dermatologists often combine two approaches rather than using just one. Keloids removed by surgery alone recur at very high rates; adding post-operative corticosteroid injections or radiation significantly reduces but does not eliminate that risk.

Are there any effective home remedies for keloids?

No home remedy has been shown in rigorous studies to reliably remove a keloid. Over-the-counter silicone gel or silicone sheeting can help prevent keloid formation or slow early growth as an adjunct, but is not sufficient treatment for an established keloid on its own. A dermatologist consultation is the appropriate first step.

Are keloids dangerous or cancerous?

Keloids are benign (non-cancerous) overgrowths of scar tissue. They do not become malignant. However, a growth that was not preceded by any wound or skin injury, or that is rapidly enlarging or ulcerating, warrants clinical evaluation to confirm the diagnosis.

Are keloids more common in certain people?

Yes. Keloids are significantly more common in people with darker skin tones, particularly those of African, Hispanic, and Asian descent. They also run in families — a family history of keloid formation is one of the strongest predictors that a raised scar is a true keloid and will recur after treatment.

Talk to a clinician

Nina Osei, NP — Nurse Practitioner

checkups, refills & skin. Gale can match you with a licensed clinician for a visit.

Find care →

When to seek evaluation

  • —A raised growth that was not preceded by any wound, piercing, or skin trauma — a spontaneous raised lesion needs clinical evaluation to rule out other causes
  • —A raised scar that is growing rapidly, becomes painful, or develops open areas (ulceration) — prompt evaluation is appropriate to confirm the diagnosis
  • —Any scar that looks different from previous keloids you have had, or that a clinician has not yet examined

This article provides general health information and does not constitute a diagnosis or personalized treatment recommendation. Only a licensed dermatologist who has examined your specific scar can recommend the appropriate treatment for you.

References

  1. 1.Walsh LA, Wu E, Pontes D, Kwan KR, Poondru S, Miller CH, Kundu RV (2023). Keloid treatments: an evidence-based systematic review of recent advances. Systematic Reviews. doi:10.1186/s13643-023-02192-7 ✓First-line therapy (silicone + corticosteroid injections); combination therapy superiority; cryotherapy evidence; radiation recurrence rates; silicone gel evidence
  2. 2.James AJ, Torres-Guzman RA, Chaker SC, Sigel ME, Perdikis G, Supp DM, Dale Slater EL (2024). Global insights into keloid formation: An international systematic review of regional genetic risk factors and commonalities. Wound Repair and Regeneration. doi:10.1111/wrr.13203 ✓Prevalence in darker skin tones and genetic/familial predisposition to keloid formation
  3. 3.McGinty S, Siddiqui WJ (2023). Keloid. StatPearls [Internet], StatPearls Publishing. PMID 29939676 ✓Corticosteroid injections as most widely used first-line treatment; pathophysiology overview
  4. 4.Reid D, Malak S, Khadka M, Hanna R, Pharr T, Wyant WA, Albers S (2025). Keloids and hypertrophic scars in individuals with darker Fitzpatrick skin types: a systematic review of treatment efficacy and quality of life outcomes. Archives of Dermatological Research. doi:10.1007/s00403-025-04292-x ✓Treatment considerations and side effect profile in patients with darker Fitzpatrick skin types
  5. 5.Hietanen KE, Järvinen TA, Huhtala H, Tolonen TT, Kuokkanen HO, Kaartinen IS (2019). Treatment of keloid scars with intralesional triamcinolone and 5-fluorouracil injections — a randomized controlled trial. Journal of Plastic, Reconstructive & Aesthetic Surgery. doi:10.1016/j.bjps.2018.05.052 ✓Comparison of triamcinolone versus 5-FU: similar remission rates, substantially less skin atrophy and telangiectasia with 5-FU
  6. 6.Bjerremand JR, Haerskjold A, Karmisholt KE (2023). Excision and adjuvant treatment to prevent keloid recurrence — a systematic review of prospective, clinical, controlled trials. Journal of Plastic Surgery and Hand Surgery. doi:10.1080/2000656X.2022.2097251 ✓Near-100% recurrence after excision alone; necessity of adjuvant treatment after surgical removal
  7. 7.Zhang Y, Wu M, Liu D, Panayi AC, Xu X, Luo L, Feng J, Ou Y, Lin T, Cui Y (2024). Recurrence and Complications of Peri-operative Steroid Injection of Keloids: A Systematic Review and Meta-analysis. Aesthetic Plastic Surgery. doi:10.1007/s00266-024-03935-0 ✓Post-operative steroid injection produces lower recurrence than intraoperative injection after keloid excision

7 sources, numbered by first appearance. General health information, not medical advice — synthetic demonstration content.