KELOID & HYPERTROPHIC Scars

Keloid scars extend beyond the original wound site, growing into thick, raised, and often irregular shapes. They result from an overactive healing process in which fibroblasts continue producing collagen long after the wound has healed. Unlike normal scars, keloids do not regress over time and may continue growing for months or even years after the initial injury. Here are some of the key characteristics of keloid scars:

• Extend beyond the original wound boundaries
• Appear thick, raised, and smooth, often with a shiny surface
• May be red, pink, or darker than the surrounding skin
• Can cause itching, tenderness, or discomfort
• Commonly develop on the chest, shoulders, upper back, earlobes, and jawline
• More prevalent in individuals with darker skin tones, particularly those of African, Asian, or Hispanic descent

Keloids can develop after surgical incisions, burns, acne, piercings, tattoos, and even minor cuts. They have a high recurrence rate even after treatment, making proper management essential.

Hypertrophic scars are also raised and thick, but they remain confined to the original wound area. Unlike keloids, hypertrophic scars may improve naturally over time, though they can take months or years to flatten and fade. These scars result from an excessive but temporary increase in collagen production during the healing process. The key characteristics of hypertrophic scars include:

• Stay within the wound’s original boundary
• Can be red or pink and feel firm to the touch
• Often improve or fade over time without intervention
• May cause tightness or discomfort, particularly if located near a joint
• Commonly occur after surgical procedures, burns, cuts, or traumatic skin injuries

Hypertrophic scars are more common than keloids and can be managed with less aggressive treatment methods. However, they can still cause functional and aesthetic concerns, especially if they develop in highly visible areas or restrict movement.

Keloid and hypertrophic scars are characterised by their raised, thickened appearance, but they have distinct differences in how they develop and behave. Recognising their symptoms early can help in seeking appropriate treatment before they become more prominent.

Signs and Symptoms of Keloid Scars:

• Extend beyond the original wound boundaries
• Raised, thick, and smooth texture
• Shiny or rubbery surface
• Pink, red, or darker than surrounding skin
• Persistent growth over months or years
• Itching, tenderness, or pain
• Can feel firm or hard to the touch
• Commonly occur on the chest, shoulders, upper back, jawline, and earlobes

Signs and Symptoms of Hypertrophic Scars:

• Confined to the original wound area
• Raised and thick but not excessively overgrown
• Firm and may feel tight or restrictive
• Red or pink in colour, often fading over time
• Can cause mild discomfort or itching
• More likely to improve naturally over time
• Commonly found in areas with high skin tension, such as joints or surgical sites

If you notice any of these signs developing after a wound heals, early intervention can help manage the scar and prevent further thickening.

Certain individuals are more prone to developing keloid and hypertrophic scars due to genetic, biological, and environmental factors. In Singapore, where diverse ethnic backgrounds and tropical climate conditions influence skin healing, some groups are at higher risk of excessive scarring. Groups at higher risk include: 

• Individuals with darker skin tones — those of Asian, Malay, Indian, and African descent have a higher likelihood of developing keloids due to increased melanin activity and fibroblast sensitivity.
• People with a family history of keloids — genetic predisposition plays a significant role, and those with close relatives who develop keloid scars are more likely to experience them.
• Young adults and teenagers — keloids and hypertrophic scars commonly develop between the ages of 10 and 30, as collagen production is more active during these years.
• Individuals undergoing surgery or cosmetic procedures — those having elective procedures like mole removal, piercings, tattoos, or aesthetic treatments may develop raised scars if they are prone to excessive collagen production.
• People with acne-prone skin — severe acne (link to service page), particularly cystic acne, can lead to keloid and hypertrophic scarring, especially on the chest, back, and jawline.
• Individuals with burn injuries or deep wounds — skin trauma from burns, accidents, or surgical incisions increases the risk of excessive scarring, particularly if healing is prolonged or complications arise.
• Pregnant women or those experiencing hormonal changes — hormonal fluctuations can influence fibroblast activity, making scars more likely to develop and grow.

At Cove Aesthetic Clinic, we take a personalised approach to assessing and diagnosing scars to ensure the most effective treatment plan for each individual. Keloid and hypertrophic scars have distinct characteristics, and an accurate diagnosis is essential for selecting the right treatment. 

During your consultation, we use a combination of clinical examination and diagnostic techniques to evaluate the scar’s nature, severity, and potential for further growth. Our diagnostic approach generally involves: 

• Comprehensive skin assessment — our specialists carefully examine the scar’s size, shape, texture, and colour to determine whether it is a keloid or hypertrophic scar.
• Patient medical history — we discuss your history of scarring, previous treatments, and any family history of keloid formation to assess your risk factors.
• Scar growth pattern analysis — keloid scars tend to extend beyond the original wound, while hypertrophic scars stay within the injury site. Understanding this growth behaviour helps us distinguish between the two.
• Symptom evaluation — if you experience itching, pain, or discomfort, we consider these symptoms in the diagnosis, as keloid scars often cause more persistent irritation.
• Skin elasticity and tension testing — areas with higher skin tension are more likely to develop hypertrophic scars. We assess how the scar responds to movement and pressure.
• Digital imaging and measurement — for precise tracking, we may use imaging tools to document the scar’s progress over time and monitor any changes in thickness or spread.

Ultimately, the goal of treatment is to minimise its appearance, relieve any discomfort, and prevent recurrence.

• Corticosteroid injections — we use targeted steroid injections to reduce inflammation, flatten raised scars, and relieve symptoms such as itching and discomfort. This is one of the most effective treatments for both keloid and hypertrophic scars.
• Silicone gel therapy — our medical-grade silicone sheets and gels help hydrate the scar, regulate collagen production, and gradually soften its appearance.
• Laser therapy — we utilise laser technology (link to service page) to improve skin texture, reduce redness, and stimulate collagen remodelling, which helps scars blend more naturally with surrounding skin.

If you are struggling with a keloid or hypertrophic scar and want a personalised treatment plan, schedule a consultation with our doctors today to achieve smoother, healthier-looking skin.