Why do keloids come back after removal, and what actually works?

What a keloid is

A keloid is a scar that keeps growing beyond the edge of the original wound. It is firm, raised, often shiny, and can itch or hurt. Keloids are much commoner on Black skin and often run in families. They follow ear piercing, acne, vaccinations, tribal or facial marks, surgery, and sometimes tiny injuries you do not remember. The chest, shoulders, upper back, jaw and earlobes are common places.

A keloid is not cancer and is not infectious. It is a nuisance and, for many people, a source of distress.

Why cutting alone fails

When a keloid is cut out, the body heals the new wound the same way it healed the first one, with too much scar. That is why surgery alone often brings the keloid back, sometimes larger than before. It is the single most common mistake, and it is why you should be wary of anyone offering a quick removal with no follow-up plan.

What works

Treatment is usually a combination, planned at the start and carried out over months:

• Steroid injections into the keloid, repeated every few weeks, to flatten and soften it. Often the first treatment, especially for small or growing keloids
• Surgical removal followed by steroid injections into the wound, starting at the time of surgery
• Pressure: special pressure earrings after an earlobe keloid, or pressure garments elsewhere, worn for months
• Silicone gel or sheets over the healed scar
• Freezing (cryotherapy), sometimes combined with injections
• For stubborn or recurrent keloids, radiotherapy given soon after removal, arranged with a specialist centre

What to avoid

Do not tie a thread or hair tightly around a keloid to make it drop off, and do not let anyone burn or cut it at home or in a salon. Avoid creams that promise to 'melt' keloids, and bleaching products on the scar, which thin the skin. If you know you form keloids, avoid new piercings and tattoos, and tell any doctor before surgery.

What to expect

Most keloid removals are done under local anaesthetic as a day case, with stitches out in one to two weeks. The real work is the follow-up visits for injections or pressure. Steroid injections can lighten or thin the skin, which shows more on dark skin and usually improves. A keloid can still return despite good treatment; when it does, catching it early makes it easier to treat. Anyone who promises a keloid will never come back is not being straight with you.

See a doctor sooner if

A lump that grows very fast, bleeds, ulcerates, or does not look like your other keloids should be examined, and removed tissue can be sent for testing. A scar that becomes hot, swollen, painful or leaks pus may be infected and needs care the same day.

Common questions