Many people struggle with keloid scars that appear on the face, body, and especially around the ears.

 

Keloids are a type of skin condition for which the exact cause and definitive treatment have not yet been established,
and a variety of theories and therapeutic approaches currently exist.

 

In other words, keloids are considered one of the intractable dermatological conditions with no clearly defined cause or cure.

 

It’s also important to note that not all large scars are necessarily keloids.

In this article, we’ll explain how to distinguish keloids from other types of scars—especially hypertrophic scars—
and we’ll also cover their causes and compare the different treatment options available.

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1. What Is a Keloid Scar?

A keloid is an abnormal scar that forms when the skin reacts to injury or irritation by producing an excessive amount of collagen.

 

As shown in illustrations, keloids tend to extend beyond the original wound boundaries and protrude above the surface of the skin.

They often continue to grow gradually over a period of several years

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2. The Difference Between Keloids and Hypertrophic Scars

The condition most similar to a keloid is a hypertrophic scar.

 

Both involve the formation of reddish, fibrotic tissue at the site of injury,
but the key difference lies in whether the scar extends beyond the boundaries of the original wound.

📷 Hypertrophic Scar
Source: Keloid Pathogenesis and Treatment / Ali Al-Attar, M.D.

 

Histologically, collagen fibers in hypertrophic scars are arranged in a more orderly fashion,
whereas in keloids, the collagen fibers are disorganized, tangled, and excessively proliferated,
causing the scar to become larger and more elevated.

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Comparison Table:

Feature	Keloid Scar	Hypertrophic Scar
Cause	Failed remodeling during wound healing + excessive collagen production by fibroblasts	Excessive collagen production by fibroblasts (remodeling remains normal)
Onset	Gradually develops over several months	Appears within a few weeks after injury
Symptoms	Often causes intense itching and pain	Usually asymptomatic
Spread	Extends beyond the original wound area and does not heal on its own	Stays within the boundaries of the wound and may gradually resolve
Histology	Randomly arranged Type I and III collagen fibers	Parallel-arranged Type III collagen fibers

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3. Causes of Keloid Formation

Keloids commonly develop in areas with a high concentration of sebaceous glands, such as the chest, shoulders, and groin,
while they are rarely seen on areas without sebaceous glands, like the palms of the hands and soles of the feet.

 

This has led to the hypothesis that sebaceous glands may play a role in keloid formation.

However, it is also believed that keloids tend to form more easily in areas with frequent movement and mechanical tension.

 

Studies suggest that mechanical tension not only promotes the proliferation of fibroblasts and collagen production,
but also affects the structure and alignment of collagen, influencing scar remodeling.

 

In addition, abnormal immune responses and associations with certain HLA (human leukocyte antigen) subtypes
suggest that genetic factors may also contribute to keloid development.

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4. Keloid Injection Therapy (Steroid Injections)

📄 出典：A Novel Method of Steroid Delivery to Improve the Efficacy of Intralesional Injection in Keloid Treatment / Cho, Mi Yeon MD

 

In dermatology clinics, Triamcinolone acetonide is commonly used for injection therapy in the treatment of keloids.

 

The concentration typically ranges from 10 to 40 mg/ml, depending on the severity and characteristics of the lesion.

 

Although "Triamcinolone acetonide" may sound complex,
it is the same active ingredient found in what’s often referred to as an "anti-inflammatory" or "anti-swelling" injection.

 

This steroid injection works by suppressing collagen production,
and despite its simple mechanism, it has shown high efficacy,
making it the first-line treatment in many dermatology practices.

 

However, the formulation and additives used in the injection may vary from clinic to clinic.

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5. Laser Treatment for Keloids

 

Laser therapy for keloids often involves devices such as the long-pulse PDL (585–595 nm) or the Nd:YAG laser (1064 nm).

 

The principle behind laser treatment is to target the blood vessels within the scar,
delivering thermal energy to suppress the growth and proliferation of the scar tissue.

 

In terms of timing, laser treatment is most effective when performed during the scar formation phase,
rather than after the scar has fully matured.

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6. Other Treatment Options for Keloids

▶ Topical Treatments: Silicone Gels and Silicone Patches

 

As mentioned earlier, since multiple factors contribute to keloid formation,
a multimodal approach is generally the most effective.

 

For individuals who are prone to developing keloids, prevention is especially important,
and one of the most recommended options is the use of over-the-counter silicone gels or silicone patches.

 

These products help reduce tension on the scar tissue and prevent the wound from drying out,
making them a cost-effective, painless, and practical method for keloid prevention.

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▶ What if a keloid has already formed?

 

Once a keloid has developed, the focus shifts to reducing its size and thickness.

 

For larger keloids, CO2 laser treatment, cryotherapy (freezing), or surgical excision may be necessary to remove the bulk of the scar tissue.

However, simply removing a keloid through surgery alone often carries a high risk of recurrence,
so it’s important to combine surgical excision with other forms of treatment.

 

For smaller keloids, steroid or immunosuppressive injections are usually the first choice,
and laser therapy during the scar formation phase can also be effective.

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7. Conclusion

 

Since many different factors contribute to the formation of keloid scars,
it's generally difficult to achieve improvement with a single treatment method.

 

At our clinic, we evaluate each case based on the size, location, and stage of keloid formation,
and we determine whether to begin with surgery, laser therapy, or injection-based treatment.

 

For at-home prevention, we still recommend silicone gels as the most convenient and effective option 😊

 

We hope this information is helpful to many of you.

 

If you have any questions, please feel free to leave a like or comment—we're happy to assist you.

 

Thank you!

 

📍 Primi Clinic
3F, 52 Seongsuil-ro, Seongdong-gu, Seoul (Primi Clinic)