Keloids and hypertrophic scars – a brief overview
| What are | Raised, thickened scars, often red, itchy or tender |
|---|---|
| Examination | Dermatological examination and assessment of the type, age, and activity of the scar |
| Treatments we offer | Corticosteroid scar injections, CO2 laser and redness treatments (Yellow laser and DYE VL) |
| Treatment plan | A course of treatment, often combination therapy; the protocol is determined by the physician |
| When to start | The sooner after the scar has formed, because younger scars respond better |
| Follow-up | Checks assessing height, firmness, colour and symptoms |
Difference between a keloid and a hypertrophic scar
Both scars occur when the skin produces too much connective tissue during healing, but they differ in how they spread and how they behave over time.
| Feature | Keloid | Hypertrophic scar |
|---|---|---|
| Borders | It can cross the boundaries of the original injury | It remains within the bounds of the injury |
| Course of development | It can continue to grow over time | Over time, it can become less pronounced |
| Symptoms | Possible itching, pain or tightness | Possible itching, pain or tightness |
| Treatment plan | It often requires a combined approach and monitoring | It depends on maturity, thickness, colour and localisation |
Raised scars are different from depressed ones, which remain after acne. More about them can be found on the page acne scars.
How are they formed and who is more prone?
Keloids and hypertrophic scars occur when the skin responds to injury by producing too much connective tissue. They appear after surgeries and cuts, burns, piercings, skin inflammations and inflammatory changes, including acne, and in prone individuals sometimes without a clear cause. Unlike raised scars, sunken acne scars require a different approach, for example subcision.
They are more prone in people who already have a keloid or keloids in the family, as well as in darker-skinned individuals. They are more common on the chest, shoulders, back, neck, earlobes, and along the jawline, i.e. in places where the skin is subjected to tension. The tendency to form keloids is also important when planning aesthetic procedures, as it influences the choice of treatment.
What does the examination involve?
Diagnosis is made by dermatologist During the examination, the appearance, borders, firmness and colour of the scar are assessed, as well as whether it is changing and causing any symptoms. It is important to state when the scar formed, what preceded it and which treatments have been used so far.
A clinical examination is usually sufficient for diagnosis. When the appearance of the lesion is not typical, the doctor may recommend additional diagnostics, such as skin biopsies. Following the examination, the goal of the therapy is agreed upon: reduction of elevation, alleviation of redness, softening of the tissue, or reduction of itching and tightness.
How are keloids and hypertrophic scars treated?
Corticosteroid injections
The corticosteroid is injected directly into the scar tissue. Therapy can help reduce thickening, redness, itching and tightness. The number of applications and intervals are determined by the doctor according to the scar's response, and follow-up appointments assess the effect and possible local reactions, such as pigment changes or thinning of the skin at the application site.
CO2 laser for existing scars
Redness treatments – Yellow laser and DYE VL
For fresh, red and vascularly active scars, the following are used Yellow laser and DYE VL, a light treatment based on AFT technology. They act on the blood vessels within the scar, reducing redness and helping the scar blend better in colour with the surrounding skin. They affect the thickness of the scar indirectly, so for raised lesions they are combined with other methods.
Combination therapy
For keloids, multiple methods are most commonly combined, as a single one does not affect all the characteristics of the scar: injection therapy for the thickening, redness treatments for the colour, and laser for the structure. The sequence and intervals are determined by the doctor according to the scar's response.
Silicone preparations and compression therapy
Silicone gels and silicone sheets are applied to healed skin, on the recommendation of a doctor, and are worn daily for an extended period. They are not placed on an open wound. Compression therapy is a separate procedure: pressure is applied to the scar using an elastic bandage, garments or special inserts, most commonly for post-burn scars and on certain regions. Both methods are used as a supplement, not as a replacement for therapy prescribed by a doctor.
How many treatments are needed and how is the result monitored?
The number of treatments and intervals depend on the type of scar, its age and the response to previous therapy. During follow-up appointments, the height, firmness and colour of the scar and the symptoms it causes are assessed, so the plan is adjusted if necessary.
The result develops gradually, over several months. With keloids, re-thickening is possible, which is why follow-up is part of the treatment. If renewed growth, redness or itching is noticed, it is helpful to contact [the clinic/doctor] earlier for a control assessment.
Aftercare following treatment
After corticosteroid injections The application site can be sensitive, and bruising is possible. Everyday activities are resumed immediately, and the area must not be massaged or exposed to unnecessary irritation.
After ablative laser treatment Redness, swelling and crusting occur, and the skin is cared for according to the doctor's instructions, using products for skin repair and sun protection. The crusts must not be removed.
After redness treatment The skin is usually briefly red and warm to the touch, with no special recovery needed.
Sun protection is important after all treatments, as the sun can increase redness and scar pigmentation. Silicone preparations are used as recommended by a doctor and only on healed skin.
Cost of treatment for keloids and hypertrophic scars
The price depends on the type, size and number of scars and the proposed procedure. Consultation prices can be found in dermatology price list, and the prices of laser treatments in price list for laser treatments. A photograph of the scar can be sent via Viber or WhatsApp N/A 064 237 0707, as a rough price guide, while the final treatment plan is determined after the examination.
Who carries out the examination and treatment of scars?
Frequently asked questions about keloids
Can a keloid be completely removed?
Therapy can significantly reduce the elevation of the scar and the discomfort it causes, while the complete disappearance of a keloid is rarely a realistic outcome. The goal and expected result are determined according to the specific scar, and with keloids, continued monitoring is also important, as the lesion can recur.
What is the difference between a keloid and a hypertrophic scar?
A keloid can extend beyond the borders of the original injury and continue to grow, whereas a hypertrophic scar remains within the boundaries of the injury and may become less pronounced over time. Both types can cause itching, pain or tightness.
Are keloids treated with a CO2 laser?
For selected scars, I can. A CO2 laser is used with targeted precision, most often in combination with injection therapy, and the doctor assesses whether a specific scar is suitable for that treatment based on its type, activity, and location.
Are corticosteroid injections painful?
During application, a brief stinging or pressure sensation is felt, as the scar tissue is firm. The procedure itself is short, and an anaesthetic cream or cooling is applied if necessary.
How many treatments are needed?
It depends on the type and size of the scar and the response to treatment. A series of treatments is usually required at intervals determined by the doctor, along with follow-up appointments to assess progress.
Can a scar thicken again?
With keloids this is possible even after successful therapy, so the result is maintained through monitoring and, where necessary, additional treatments. With hypertrophic scars, re-thickening is less common.
When should a post-operative scar be checked?
The scar is assessed once the wound has healed and the stitches have been removed. Early examination is useful for individuals who have previously had a keloid, as therapy can then be started in good time, while the scar is young.
Can old scars be treated?
I can, but older and more mature scars usually respond more slowly and require more treatments than fresh ones. An assessment is made during the consultation.
Can a treatment plan be determined from a photograph?
No. The photograph serves as a rough guide regarding potential treatments and pricing, whereas the type of scar, its activity and the treatment plan are only determined during the consultation.
Why is a predisposition to keloids a contraindication for aesthetic CO2 treatment?
Because in individuals prone to keloids, any skin injury, including a large-scale aesthetic ablative treatment, can trigger the formation of a new scar. Targeted treatment of an existing keloid is a separate medical indication, which the doctor assesses on a case-by-case basis.
Book a scar consultation in Belgrade
The Imedic Polyclinic is located at Kneza Miloša 23 street, 2nd floor, Belgrade. Opening hours: Monday–Sunday, 9:00–21:00.
Appointments are made by phone: 064 237 0707. If you contact us from abroad, we are also available via Viber and WhatsApp on the same number.
Author: Dr Ivica Jeremić
Doctor of Medical Sciences (Molecular Medicine and Immunology), subspecialist in rheumatology, dermatology resident.
Updated:
Expert sources
- American Academy of Dermatology Keloids: Diagnosis and treatment.
- Gold MH, McGuire M, Mustoe TA, et al. Updated international clinical recommendations on scar management: part 2 – algorithms for scar prevention and treatment. Dermatological Surgery, 2014. PMID: 25068544.
- Monstrey S, Middelkoop E, Vranckx JJ, et al. Updated scar management practical guidelines: non-invasive and invasive measures. 2014. PMID: 24888226.
