Keloid Scars

Keloid Scars (Singapore)

Keloids are not merely scars. Instead, keloids are a wound-healing disorder where the skin produces excess scar tissue beyond the original injury to a raised growth that can be itchy, tender, and emotionally distressing. Keloids can also continue to enlarge over months to years and may recur after treatment if not managed strategically.

At The Skin Longevity Clinic, Dr Rachel Ho takes an evidence-based, stepwise approach to flatten keloids, control symptoms, reduce recurrence.

What are keloid scars?

A keloid is a type of abnormal scar that:

  • Grows beyond the boundaries of the original wound
  • Is often raised, smooth, firm, and can be pink, red or brown depending on skin tone
  • Commonly appears on the chest, shoulders, upper back, jawline, and earlobes 


Keloids are not the same as hypertrophic scars which stay within the original wound edges and may improve over time.

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Why do keloid scars form?

Keloids form when the healing response becomes excessive.  Instead of stopping once the skin has closed, the body continues to signal:

  • persistent inflammation
  • fibroblast activity 
  • excess collagen and extracellular matrix production

Risk factors and triggers

Keloids scars are multifactorial in nature; and are due to a combination of genetics,  skin tension at the wound site and concomitant inflammation.

Common risk factors and triggers include:

  • Personal or family history of keloids 
  • Darker skin tones 
  • Skin injury or inflammation: acne lesions, cuts, burns, surgery, vaccinations, piercings 
  • High-tension body sites (chest, shoulders, upper back)

Categorisation of keloid scars

 

Clinically, we categorise keloids in ways that directly affect treatment choice:

  1. Keloid vs hypertrophic scar  
  2. Activity:
    • Active: enlarging, red, itchy/painful
    • Stable: size unchanged, less symptomatic
  3. Location-risk: areas like the chest/shoulders tend to have higher recurrence than earlobes

 

Signs and symptoms

 

You may notice:

  • A raised, thickened scar that extends beyond the original wound
  • Itch, tenderness, pain, tightness, or sensitivity
  • Ongoing growth months after the injury

 

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FAQs

How can keloids be treated?

Evidence consistently supports combination therapy tailored to scar type, symptoms, and site. 

1) First-line clinic-based treatments


Intralesional corticosteroid injections 

  • Helps flatten and soften keloids and reduce itch/pain
  • Often performed as a series (not a one-off) 


Silicone gel/silicone sheeting 

  • Helps with hydration of the scar surface and symptom control
  • Commonly used alongside procedures, including after surgery 


2)  For thicker or more resistant keloids


Steroid + 5-Fluorouracil (5-FU) injections

  • Increasingly used when steroids alone are inadequate
  • Systematic reviews support effectiveness, with combination approaches commonly used in practice 


Laser-assisted scar treatment 

  • Often used as an adjunct to improve colour and texture and enhance medication penetration 


3) Surgery (for selected keloids) 


Excision alone has a high recurrence risk, which is why modern practice typically pairs surgery with adjuvant strategies (e.g., injections, silicone, and in selected cases, radiotherapy).

Doctor Rachel’s Takeaway

Keloids are treatable and respond well to a structured plan where to reduce thickness, control symptoms, and protect against recurrence. This is especially relevant in high-tension anatomical sites like the chest and shoulders.