Quick answer. Keloids are raised overgrowths of scar tissue that extend beyond the original wound, and they form more easily in darker and Asian skin. Common triggers include ear piercings, acne, surgery, vaccinations and other skin injuries; the ears, jawline, neck, chest, upper back and shoulders are especially prone. First-line treatment is usually intralesional steroid injection, often with silicone gel or sheets, cryotherapy and sometimes laser. Surgery alone recurs often, so it is combined with steroid injections and occasionally radiotherapy. Keloids commonly recur, so realistic expectations and prevention matter. See a dermatologist early; treatment is often cosmetic and may not be MediSave-claimable.
Keloids are raised, firm overgrowths of scar tissue that grow beyond the boundaries of the original wound. They can itch, feel tender and cause sharp, shooting pains when pressed. Unlike a normal scar, a keloid keeps growing rather than fading.
Keloids form where the skin has been injured by surgery, blisters, vaccinations, acne or body piercings, and sometimes with no obvious injury. People with darker and Asian skin form them more easily. This guide explains how keloids differ from hypertrophic scars, the treatments used in Singapore, and the honest truth about recurrence.
At a glance
| Feature / Treatment | Keloid | Hypertrophic scar |
|---|---|---|
| Growth pattern | Grows beyond the original wound edges | Stays within the wound boundary |
| Natural course | Persists, may keep enlarging | Often flattens over months to years |
| Steroid injection | Common first-line; given monthly over sessions | Effective; usually fewer sessions |
| Silicone gel / sheets | Adjunct; worn or applied for 2-3 months | First-line for many cases |
| Cryotherapy | Used, repeated monthly sessions | Sometimes used |
| Surgery + adjuvant | Surgery alone recurs; combined with steroid/radiotherapy | Surgery less often needed |
Keloids versus hypertrophic scars
Both are raised scars, but they behave differently:
- Keloids grow beyond the edges of the original wound, can keep enlarging and rarely settle on their own.
- Hypertrophic scars stay within the wound boundary and often flatten gradually over months to years.
This distinction matters because keloids are harder to treat and far more likely to recur. A dermatologist can usually tell them apart on examination.
Who is at higher risk
Anyone can form a keloid, but some people are much more prone:
- Darker and Asian skin types form keloids more easily, which is relevant for many people in Singapore.
- A personal or family history of keloids increases risk.
- Certain sites are especially prone: the ears (including ear-piercing keloids), jawline, neck, upper chest, upper back and shoulders.
If you know you are keloid-prone, think carefully before elective piercings or non-essential procedures in high-risk areas.
Treatment options in Singapore
Keloids are managed with a combination of treatments rather than a single cure:
- Intralesional corticosteroid injection: a common first-line treatment, injected directly into the keloid, often monthly over several sessions to flatten and soften it.
- Silicone gel and sheets: silicone gel sheets are typically worn over the scar for at least 12 hours a day, or silicone gel applied twice daily, for 2-3 months.
- Cryotherapy: liquid nitrogen applied to the keloid, usually in repeated monthly sessions.
- Laser: used in selected cases to improve redness and texture.
- Surgery: removal is associated with a high recurrence rate, so it is combined with adjuvant treatment such as steroid injections (and occasionally radiotherapy) to lower the chance of regrowth.
Surgery, radiotherapy and ear-piercing keloids
Surgery on its own often makes keloids come back, sometimes larger, so it is rarely done alone.
- Excision is usually paired with perioperative steroid injections and silicone therapy to reduce recurrence.
- Radiotherapy is an established adjunct for keloids but is used selectively and reserved for resistant cases.
- Ear-piercing keloids are common; treatment may combine surgical removal with steroid injections and pressure devices to lower the recurrence risk.
Prevention and recurrence honesty
Prevention is easier than treatment, especially for keloid-prone people:
- Avoid unnecessary skin trauma, piercings and elective procedures in high-risk areas if you scar badly.
- Treat acne and wounds early, and use silicone gel or sheets on new high-risk wounds as advised.
Be realistic about results. Keloids commonly recur even after appropriate treatment, and the aim is usually to flatten, soften and reduce symptoms rather than to guarantee complete, permanent removal. Multiple sessions and ongoing follow-up are normal.
When to see a dermatologist
See a dermatologist (or plastic surgeon) if:
- A scar is growing beyond the original wound, thickening, itching or painful.
- You have a keloid that bothers you cosmetically or with symptoms.
- You are keloid-prone and need advice before surgery, piercing or other procedures.
Early treatment of a developing keloid is generally more effective than waiting until it is large. Note that keloid treatment for cosmetic reasons may not be MediSave-claimable; check with your clinic.
What to expect at the appointment
A dermatologist or plastic surgeon will examine the scar, ask how long it has been present, whether it is growing, itching or painful, and review any history of keloids in you or your family. Treatment such as a steroid injection may sometimes be started during the same visit. Steroid injections can sting, and several monthly sessions are usually planned rather than a single treatment. The doctor will set out a realistic goal, which is normally to flatten, soften and calm symptoms rather than to remove the scar completely.
Self-care and prevention at home
- Apply silicone gel or wear silicone sheets as advised, consistently over weeks to months, as benefit comes from regular use.
- Protect new or treated scars from sun exposure to reduce darkening.
- Avoid scratching or picking, which can aggravate a keloid.
- If you scar badly, think carefully before elective piercings, tattoos or non-essential procedures in high-risk areas such as the ears, chest and shoulders.
Questions to ask your doctor
- Is this a keloid or a hypertrophic scar, and how does that change treatment?
- What combination of treatments do you recommend, and over how many sessions?
- What is the likely chance of recurrence in my case?
- Is surgery worth considering, and what would be done to lower the risk of regrowth?
Common questions
Can a keloid be removed completely and permanently?
Complete, guaranteed removal is rarely possible. Keloids commonly recur, so the aim is usually to reduce size, symptoms and appearance with ongoing follow-up.
Is keloid treatment claimable?
When done for cosmetic reasons it may not be claimable. Check with your clinic about costs before starting.
Related guides
- Best Dermatology Clinics in Singapore — our editorial shortlist
- dermatology clinics directory
- Melasma treatment
- Viral warts treatment
- Hyperhidrosis (excessive sweating)
Sources
- National Skin Centre – Keloids (NHG Health)
- National Skin Centre (NHG Health) overview
- Icon Cancer Centre Singapore – Keloid Scars (radiotherapy)
- HealthHub Singapore – Diseases and Conditions
Part of our Skin health guides · Browse all health topics