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Fibroproliferative Physician Reviewed

Keloids — flattened by dermatologists, not left to grow

Raised scars that grow beyond the original wound, disproportionately affecting Indian skin. Evidence-based multimodal treatment at DermaVue's 7 clinics across Kerala & Tamil Nadu.

Keloid Scars Hypertrophic Scars Raised Scars Cicatrix
Affects Ears, Chest, Shoulders, Back
Age Group 10 – 40 years
Contagious No
Treatment 3 – 8 sessions
Consultation ₹300
At a Glance
0%
prevalence in darker-skinned populations (Fitzpatrick IV–VI) vs 0.1% in Caucasians
0.7%
estimated keloid prevalence in the Indian subcontinent population
0%+
DermaVue patient satisfaction across 7,400+ reviews
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7 clinics · Kerala & Tamil Nadu · ₹300 consultation

What Is It

Understanding Keloids

Reviewed by Dr. Minu Liz Mathew, MBBS MD DVL — February 2026

A keloid is a raised, thickened scar that grows beyond the boundaries of the original wound. Unlike normal scars that flatten over time, keloids keep expanding — sometimes months or years after the injury. They form when the body's wound-healing process goes into overdrive, producing excess collagen. Common triggers include ear piercing, surgery, burns, acne, and even minor scratches. Keloids are significantly more common in Indian skin types (Fitzpatrick IV–VI) and can cause itching, pain, and cosmetic distress. The good news: keloids are treatable. DermaVue dermatologists use a multimodal approach — combining intralesional injections, silicone therapy, laser, and cryotherapy — tailored to your keloid's size, location, and age.

Keloids (ICD-10: L91.0) are fibroproliferative disorders of the dermis characterised by exuberant extracellular matrix deposition — primarily type I and III collagen — extending beyond the confines of the original wound margin. Pathogenesis involves dysregulated fibroblast proliferation, elevated TGF-β1/TGF-β2 signalling, reduced apoptosis of keloid fibroblasts, and aberrant mechanotransduction via integrin-mediated pathways. Histologically, keloids demonstrate thick, hyalinised collagen bundles arranged in a haphazard pattern with a tongue-like advancing edge, distinguishing them from hypertrophic scars where collagen remains parallel to the epidermis.[1] Indian Fitzpatrick IV–VI skin phenotypes carry 5–15× elevated risk compared to lighter phototypes, with familial clustering suggesting autosomal dominant inheritance with incomplete penetrance and variable expression.

M
Dr. Minu Liz Mathew, MBBS MD DVL
Consultant Dermatologist · RealSelf Recognised · DermaVue Kochi
Last reviewed: February 2026
Signs & Symptoms

What does Keloids look like?

Symptoms range widely in severity. Identifying which type you have determines the right treatment.

Growth Beyond Wound

The hallmark of keloids: scar tissue extends well beyond the original wound margins and does not regress spontaneously. This distinguishes keloids from hypertrophic scars.
Mod. Severe

Raised Firm Nodule

A hard, dome-shaped or claw-like growth that is firm to rubbery in consistency. Surface may be smooth and shiny with visible telangiectasias.
Moderate

Itching (Pruritus)

Persistent itching at and around the keloid is reported in over 80% of patients. Caused by histamine release from mast cells within the scar tissue.
Moderate

Pain & Tenderness

Keloids can be spontaneously painful or tender to touch, caused by nerve entrapment within the dense fibrotic tissue. Pain correlates with active growth phase.
Moderate

Colour Change

Keloids appear pink, red, or hyperpigmented dark brown depending on skin tone and keloid age. In Indian skin, most keloids are darker than surrounding skin.
Mild

Progressive Enlargement

Unlike normal scars, keloids continue to grow over months to years. Growth can be triggered by friction, repeated trauma, or hormonal changes during pregnancy and puberty.
Mod. Severe

Restricted Movement

Large keloids over joints (shoulder, chest, neck) can restrict range of motion. Ear keloids from piercing can become pendulous and cosmetically disfiguring.
Mod. Severe

Fitzpatrick IV–VI Predisposition

Indian and darker skin types are 5–15× more likely to develop keloids. Family history of keloids in first-degree relatives is present in 50–70% of cases.
Mild
Root Causes

What actually causes Keloids?

Multiple factors act together — understanding them helps prevent recurrence after treatment.

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Genetic Predisposition

Keloid susceptibility is strongly heritable — autosomal dominant with incomplete penetrance. Multiple gene loci (HLA, NEDD4, FOXL2) have been implicated. First-degree relatives of keloid patients have a 50–70% risk. Indian populations carry significantly elevated genetic risk compared to European ancestry.
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Ear Piercing

The single most common trigger for keloids in India, especially in women. Ear cartilage piercings carry higher risk than earlobe piercings. Even a single piercing can trigger bilateral earlobe keloids in genetically predisposed individuals.
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Surgical Scars

Post-surgical keloids are common at sternotomy sites (cardiac surgery), Caesarean section scars, and deltoid injection sites (BCG vaccination). Risk is highest in areas of high skin tension — chest, shoulders, upper back.
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Burns & Trauma

Thermal burns, chemical burns, and deep abrasions can trigger keloid formation. The severity of the initial injury does not predict keloid size — even minor wounds can produce large keloids in predisposed patients.

Acne & Folliculitis

Severe cystic acne, especially on the jawline and chest, is a significant keloid trigger in Indian skin. Folliculitis barbae (razor bumps) on the beard area can also induce keloidal scarring.

Indian Skin (Fitzpatrick IV–VI)

Darker skin types produce keloids at 5–15× the rate of lighter skin. The Indian subcontinent has one of the highest keloid prevalences globally (estimated 4.7%). Mechanotransduction and melanocyte-fibroblast signalling are implicated.
Who gets keloids in India?
  • 4.7% estimated prevalence in the Indian subcontinent — among the highest globally
  • Fitzpatrick IV–VI skin types are 5–15× more likely to develop keloids than lighter skin types
  • Peak incidence 10–30 years — coinciding with puberty, when hormonal changes accelerate fibroblast activity
  • Women are more frequently affected due to ear piercing, a primary trigger in Indian populations
  • Family history present in 50–70% of keloid patients — first-degree relatives at significantly elevated risk
Diagnosis Process

What happens at your DermaVue consultation?

A structured clinical assessment — not a quick glance and a prescription pad. Here's exactly what to expect.

01

Clinical Examination & History

Dermatologist examines the scar morphology, measures dimensions, and documents growth trajectory. Full history of wound origin, time since onset, previous treatments, and family history of keloids recorded. Baseline photographs taken.
02

Keloid vs Hypertrophic Scar Differentiation

Critical distinction: keloids extend beyond original wound margins and do not regress spontaneously. Hypertrophic scars remain within wound boundaries and may flatten over 1–2 years. This classification determines treatment protocol.
03

Dermoscopy & Imaging

Dermoscopic assessment of vascular pattern and collagen architecture. Ultrasound may be used for large keloids to assess scar depth, volume, and vascularity before planning intralesional therapy or surgical excision.
04

Vancouver Scar Scale Assessment

Standardised scoring of vascularity, pigmentation, pliability, and height. This provides an objective baseline to measure treatment response over multiple sessions.
05

Personalised Multimodal Treatment Plan

Written protocol combining intralesional injections, silicone therapy, laser sessions, and preventive measures — tailored to keloid size, location, patient age, skin type, and previous treatment response.
Available at DermaVue

Keloids treatments we offer

All procedures by board-certified MD DVL dermatologists. US-FDA approved equipment. No technician-only protocols — ever.

Intralesional Corticosteroid Injection

Triamcinolone acetonide (TAC) injected directly into the keloid flattens scar tissue by inhibiting collagen synthesis and fibroblast proliferation. Gold-standard first-line treatment with 50–80% response rate over 3–6 sessions.
First-line for most keloids

Silicone Gel Sheeting & Pressure

Medical-grade silicone sheets or gel applied continuously for 12–24 hours/day hydrate the stratum corneum, regulate fibroblast growth factors, and reduce collagen overproduction. Combined with pressure earrings for ear keloids.
Prevention & early keloids

Fractional CO2 Laser

Ablative fractional resurfacing creates micro-columns of thermal injury, remodelling pathological collagen and improving scar texture, height, and pliability. Enhanced drug delivery when combined with intralesional injection post-laser.
Flattening & texture improvement

Cryotherapy

Contact or intralesional cryotherapy with liquid nitrogen induces vascular damage within the keloid, leading to tissue anoxia, necrosis, and scar flattening. Effective for small to medium keloids.
Small to medium-sized keloids

Pulsed Dye Laser (PDL)

Targets haemoglobin in keloid vasculature, reducing redness, pliability, and scar height. Particularly effective for early erythematous keloids and as adjunct to intralesional injections.
Red/vascular keloids

Surgical Excision + Adjuvant Therapy

Complete excision followed immediately by intralesional corticosteroids, silicone, and/or superficial radiation therapy to prevent recurrence. Standalone excision has >50% recurrence rate — adjuvant therapy reduces this to 10–20%.
Large or resistant keloids
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Treatment Journey

Your Keloids treatment timeline

Results are gradual, progressive, and lasting with the right protocol.

Week 1
Consultation, keloid assessment, photography, and Vancouver Scar Scale scoring. First intralesional corticosteroid injection may be administered same visit.
Silicone gel sheet or topical silicone prescribed for daily home use. Pressure earring fitted if ear keloid.
Month 1
Second intralesional injection session (4-week interval). Early softening and itching reduction typically noticed. Silicone therapy continuing daily.
Reassessment of scar height, firmness, and symptoms. Laser therapy introduced if indicated.
Month 2–3
Third to fourth injection session. Measurable scar flattening (30–50% height reduction typical). Itching and pain significantly improved.
Fractional laser or cryotherapy sessions scheduled if keloid remains resistant. Combination protocols adjusted.
Month 4–6
Ongoing multimodal treatment. 50–80% scar reduction expected. Scar becomes softer, flatter, and less symptomatic.
Interval between injections may be extended to 6–8 weeks as keloid responds. Maintenance silicone therapy continues.
Month 6+
Sustained scar improvement. Transition to maintenance and prevention phase. Long-term silicone use recommended for 6–12 months post last treatment.
Recurrence monitoring at quarterly follow-ups. Patient educated on wound care and keloid prevention for any future injuries.
Expert Videos

Watch: Keloids treatment at DermaVue

Our dermatologists explain diagnosis, treatment options, and what to expect.

Microneedling Treatment for Scar Management

FAQ

Frequently asked questions about Keloids

No, keloids are not contagious. They cannot spread from person to person through touch or any form of contact. Keloids are an abnormal wound-healing response driven by your own genetics and fibroblast biology — they are not caused by infection or any transmissible agent.

The key difference is growth beyond the wound: keloids extend beyond the original wound margins and do not spontaneously regress. Hypertrophic scars stay within wound boundaries and often flatten on their own within 1–2 years. Keloids also have a higher recurrence rate after treatment and are more common in darker skin types. Accurate differentiation is critical because treatment protocols differ.

Keloids can be significantly flattened and reduced through multimodal treatment — intralesional corticosteroids, laser, silicone, and cryotherapy. Surgical excision alone has a >50% recurrence rate, but combining excision with adjuvant therapy (injections + silicone + possible radiation) reduces recurrence to 10–20%. Complete permanent "removal" with zero recurrence risk is difficult to guarantee, which is why DermaVue uses combination protocols monitored over 6–12 months.

If you have a personal or family history of keloids, preventive measures include: applying silicone gel sheets immediately after wound closure for 3–6 months, avoiding unnecessary piercings or elective procedures in high-risk areas (chest, shoulders, ears), prophylactic intralesional corticosteroid injection at the time of suture removal, and pressure therapy for ear keloids. Consult your DermaVue dermatologist before any planned surgery if you are keloid-prone.

DermaVue consultation fee is ₹300 at most branches. Intralesional corticosteroid injection sessions range ₹1,000–3,000 depending on keloid size and number. Laser sessions and cryotherapy are priced based on treatment area. Most keloids require 3–8 sessions over several months. Full treatment costs are discussed transparently at your first consultation — no hidden charges or pressure to buy packages.

Indian skin (Fitzpatrick types IV–VI) has a genetic predisposition to keloid formation — estimated at 5–15× higher than Caucasian skin. This is linked to differences in fibroblast biology, TGF-β signalling, melanocyte-fibroblast interactions, and mechanotransduction pathways. The Indian subcontinent has one of the highest keloid prevalences globally at approximately 4.7%. Family history is present in over half of all cases, suggesting autosomal dominant inheritance.

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