What Causes A Keloid?

Keloids are raised scars that grow beyond the original wound boundary. They happen when your body produces too much collagen during healing. Unlike normal scars, keloids keep growing and can become larger than the injury that caused them.

What Exactly Is a Keloid and How Is It Different From Other Scars?

A keloid is an overgrowth of scar tissue. It forms when the skin healing process goes into overdrive. Normal scars stay within the edges of the original wound. Keloids do not. They spread outward like a tumor but are not cancerous.

Hypertrophic scars look similar but behave differently. They stay within the wound boundary. They may get smaller over time on their own. Keloids rarely shrink without treatment. They can grow for months or even years after the initial injury.

Keloids feel firm and rubbery. They can be pink, red, or darker than your surrounding skin. Some people report itching or pain. The appearance alone can be distressing, especially on visible areas like the earlobes, chest, or shoulders.

What Causes a Keloid to Form in the First Place?

The short answer is a collision of genetics and skin injury. Your genes determine how your skin heals. Some people inherit a tendency to overproduce collagen. When the skin is damaged, the repair process does not stop at the wound edges. It keeps going.

The injury itself can be anything that breaks the skin. Surgical cuts, piercings, burns, tattoos, and even severe acne can trigger a keloid. Vaccination sites are a common location. So are ear piercings. For some people, a minor scratch or bug bite is enough.

Current research suggests that specific growth factors drive keloid formation. Transforming growth factor-beta (TGF-β) is one. It signals skin cells to make more collagen. In keloid-prone people, this signal stays on too long. The result is a scar that refuses to stop growing.

As of 2026, scientists have identified several gene variants linked to keloid formation. These genes affect how your immune system responds to injury. They also influence how skin cells communicate during healing. This is why keloids often run in families.

Who Is Most Likely to Develop Keloids?

Keloids do not affect everyone equally. People with darker skin tones are at higher risk. Studies have found that people of African, Asian, and Hispanic descent develop keloids more often than people of European descent. The exact reason is not fully understood, but genetics play a major role.

Age matters too. Keloids are most common in people between 10 and 30 years old. Children and older adults get them less frequently. Hormones may be involved, but the evidence is not strong enough to say for sure.

Family history is a powerful predictor. If a parent or sibling has keloids, your risk is higher. This is one of the most consistent findings in keloid research. The genetic link is clear, though the specific genes involved vary between populations.

Body location also matters. Certain areas are more prone to keloid formation. The chest, shoulders, earlobes, and upper back are high-risk zones. The eyelids and genitals rarely develop keloids. Why some body parts are more vulnerable is still an open question in research.

What Are Common Myths About What Causes a Keloid?

One widespread myth is that keloids are caused by poor wound care. This is false. Keloids form because of how your body heals, not because you did something wrong. Keeping a wound clean and covered is always good practice, but it will not prevent a keloid if you are genetically prone.

Another myth is that keloids are contagious. They are not. You cannot catch a keloid from someone else. They are a growth of your own tissue, not an infection or virus.

Some people believe keloids are a sign of cancer. They are not. Keloids are benign growths. They do not turn into cancer. The cells in a keloid are normal skin cells, just arranged abnormally. There is no evidence linking keloids to any form of cancer.

A persistent myth is that cutting off a keloid solves the problem. This is dangerously wrong. Surgical removal alone often makes keloids grow back larger. The body sees the surgery as a new injury and responds with even more collagen. This is why treatment usually combines surgery with other therapies like radiation or steroid injections.

| Myth | Fact |
|——|——|
| Poor wound care causes keloids | Genetics determine keloid risk, not wound care |
| Keloids are contagious | They are not infectious |
| Keloids are cancerous | They are benign growths |
| Cutting them off works | Surgery alone often makes them grow back larger |

What Treatments Actually Have Evidence Behind Them?

Corticosteroid injections are the most common first-line treatment. They reduce inflammation and slow collagen production. Studies show they can flatten keloids and reduce symptoms like itching. Multiple sessions are usually needed. The results vary from person to person.

Silicone sheets or gels have moderate evidence. They create a protective barrier over the scar. Research suggests they can help soften and flatten keloids over time. They work best when used consistently for months. The effect is modest but real.

Cryotherapy freezes the keloid tissue. It can be effective for smaller keloids. Some studies show good results when combined with steroid injections. The downside is that it can lighten the skin permanently, which matters more for people with darker skin tones.

Laser therapy is another option. Pulsed dye laser targets blood vessels in the keloid. This can reduce redness and thickness. Evidence is growing but not as strong as for steroids or surgery combined with other treatments.

Surgery combined with radiation therapy has the highest success rates. The surgery removes the keloid. Low-dose radiation prevents regrowth. Studies report success rates above 80 percent for this combination. Radiation is only used for adults due to cancer risk concerns.

Pressure therapy is used mainly for ear keloids. Special earrings or clips apply constant pressure. This can prevent regrowth after surgery. Evidence is moderate. It works best when started immediately after removal and worn for months.

What Should You Avoid When Dealing With Keloids?

Avoid treatments that promise quick fixes. There is no instant cure for keloids. Any product or procedure that claims to eliminate a keloid in days is lying. Real treatments take months and often require multiple approaches.

Do not pick at or irritate a keloid. This can trigger more growth. The same applies to new piercings or tattoos in keloid-prone areas. If you know you are at risk, avoid unnecessary skin trauma.

Avoid over-the-counter scar creams that lack evidence. Most contain ingredients like vitamin E or onion extract. Research does not support their effectiveness for keloids. Some studies suggest vitamin E can even worsen scarring in some people.

Do not rely on a single treatment approach. Keloids are stubborn. The best outcomes come from combining treatments. A dermatologist who specializes in scar management can help create a plan that fits your specific situation.

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