Symptoms & Treatment: Keloid scars

Benign disease services
Keloid scars

What are keloid scars?

A keloid scar is a benign, overgrown lump that can sometimes develop when a wound heals, or even after minor skin damage such as acne or ear piercing.^2,3 They may be red or darker in colour than usual skin tone, and appear most commonly on the chest, shoulders, and ear lobes.^2,3 They are often cosmetically disfiguring but can also cause itching and pain.^2,3

Causes of keloid scars

It’s not known exactly what causes keloid scars, but they are more common in people with darker skin than lighter skin.^2,3 They usually develop in people aged 10 to 30 years but can occur at other ages.²

Keloid scars form when excessive amounts of collagen (a protein used in wound repair) are produced in areas that are healing after skin injury.^2,3 They typically develop slowly and will usually appear months after the surgery or injury to the skin.^2,3

While keloid scars and hypertrophic scars share similarities in appearance (raised and red scars), they grow differently: keloid scars grow beyond the original edges of injury into surrounding tissue, while hypertrophic scars remain within the edges of the initial injury.^2,3

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Diagnosing keloid scars

Keloids are usually diagnosed with a physical exam by a doctor looking at the skin to assess the scar area. Sometimes, a skin biopsy (where a small sample of skin is removed for testing) may be required.³

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Treatment options for keloid scars

Most options for treating keloid scarring aim to flatten and improve the appearance of the scar, as well as reduce any associated symptoms.³

Management of keloid scars may include one or more different therapies, often used in combination, that help to reduce inflammation in the skin.^1,2

Your specialist may advise you to try certain treatments to help reduce inflammation. If these treatments haven't worked for you, then careful surgery combined with precision radiation therapy may be appropriate for you.²

An initial assessment and discussion are important to help understand the uncertainties and alternative treatment options.

At the assessment, your specialist will discuss whether radiotherapy might be helpful for your condition, as well any as side-effects you may experience.

Note: You will need a referral from a GP or specialist for an assessment.

Radiation therapy

Radiation therapy may be used to treat keloid scars that can sometimes develop after injury to the skin.^1,2

It may:

Help treat keloid scars by reducing the inflammation, which in turn dampens the excess production of collagen.^1,4
Be used after surgery to prevent the scar from recurring; studies show success rates around 80% to 85% with no regrowth of the scar.^2,5
Use a technique called electron beam radiation therapy, which is delivered by a linear accelerator (LINAC).²
Often start approximately 24 to 72 hours after surgery and may be delivered in up to five treatment sessions within one week.^2,4,6

The number of treatment sessions, their duration, and treatment outcomes will vary between patients.

Side effects may occur, but these are usually mild to moderate.

For example, some patients experience mild redness of the skin immediately following treatment, which usually subsides over 3 to 4 weeks.⁵

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Content reviewed by

Review Date: October 2024

Prof Jarad Martin

MBChB BSc PhD DMed, FRANZCR GAustMS

Radiation Oncologist

Ogawa, R. (2017). Keloid and hypertrophic scars are the result of chronic inflammation in the reticular dermis. International Journal of Molecular Sciences, 18(3), 606. https://doi.org/10.3390/ijms18030606
Zainib, M., & Amin, N. P. (2023). Radiation therapy in the treatment of keloids. In StatPearls. StatPearls Publishing. Retrieved April 2023, from https://www.ncbi.nlm.nih.gov/books/NBK499973/
Australasian College of Dermatologists. (2015, August). Keloids. Retrieved April 2023, from https://www.dermcoll.edu.au/atoz/keloids/
Nast, A., Gauglitz, G., Lorenz, K., Metelmann, H.-R., Paasch, U., Strnad, V., Weidmann, M., Werner, R. N., & Bauerschmitz, J. (2021). S2k guidelines for the therapy of pathological scars (hypertrophic scars and keloids) –Update 2020. Journal der Deutschen Dermatologischen Gesellschaft, 19(2), 312-327. www.doi.org/10.1111/ddg.14279
Lee, S. Y., & Park, J. (2015). Postoperative electron beam radiotherapy for keloids: Treatment outcome and factors associated with occurrence and recurrence. Annals of Dermatology, 27(1), 53–58. https://doi.org/10.5021/ad.2015.27.1.53
Wen, P., Wang, T., Zhou, Y., Yu, Y., & Wu, C. (2021). A retrospective study of hypofractionated radiotherapy for keloids in 100 cases. Scientific Reports, 11(1), 3598. https://doi.org/10.1038/s41598-021-83190-4

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This website is provided for information purposes only. Nothing on this website is intended to be used as medical advice, or to diagnose, treat, cure or prevent any disease. It should not be used as a substitute for your own health professional's advice. Any medical procedure or treatment carries risks. Before proceeding with treatment, you should discuss the risks and benefits of the treatment with an appropriately qualified health practitioner. Individual treatment outcomes and experiences will vary.

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