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Medical Dermatology

Keloid & Hypertrophic Scars

Raised, thickened scars are more than a cosmetic concern — they can itch, hurt and keep growing. They are also notably more common in the skin tones common in Singapore, which makes them a genuine clinical niche rather than a rare problem.

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At a glance

What it is
Raised, thickened scars from an over-active wound-healing response — keloid or hypertrophic.
Who it affects
Considerably more common in darker skin tones, and often familial. A previous keloid raises the risk of another.
Common sites
Earlobes, chest, shoulders, jawline — and any site of injury, piercing, surgery or acne.
The key difference
Hypertrophic scars stay within the wound; keloids grow beyond it and rarely regress on their own.
Treatment
Combination approaches to flatten, soften and settle the scar — and prevention in those prone to them.
Understanding the condition

Why raised scars form

When skin is injured, the body repairs it by laying down collagen. Normally this process is balanced and the scar settles flat. In keloid and hypertrophic scars, the repair response is overactive and too much collagen is produced, leaving a raised, firm scar.

The distinction between the two matters:

  • A hypertrophic scar stays within the boundary of the original wound and often improves gradually over time.
  • A keloid grows beyond the edges of the original injury into normal skin, and does not tend to regress on its own — which is why it needs active management.
Particularly relevant in Singapore Keloids are considerably more common in people with darker skin tones, including many of Asian descent, and there is often a family tendency. This makes them a frequent and important concern here, and means anyone who has formed one before should take preventive steps after future skin injuries.
What sets them off

Common triggers and sites

Almost anything that breaks or inflames the skin can trigger a keloid in a susceptible person.

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Injury & surgery

  • Surgical wounds and scars
  • Cuts, burns and lacerations
  • Vaccination and injection sites
👑

Piercings & cosmetic

  • Ear piercing — the earlobe is a classic site
  • Other body piercings
  • Tattoos in susceptible skin
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Inflammatory skin

  • Severe acne, especially on the chest and back
  • Folliculitis and boils
  • Chickenpox scars
More than a cosmetic issue Keloids and hypertrophic scars are frequently itchy or tender, and a scar over a joint can limit movement. These symptoms are a legitimate reason to seek treatment in their own right.
Treatment

How raised scars are treated

Because keloids in particular tend to recur after simple removal, they are usually managed with a combination of approaches aimed at flattening, softening and settling the scar, rather than a single operation. What suits a given scar depends on its size, site, symptoms and how long it has been present.

  • Intralesional corticosteroid injections — a mainstay, to flatten and soften the scar and relieve itch
  • Silicone gel or sheeting, and pressure therapy — particularly useful early and for prevention
  • Cryotherapy and laser treatment for selected scars
  • Combination treatment, since results are usually better than any single method alone
Realistic expectations The aim of treatment is meaningful improvement — a flatter, softer, less itchy scar — and often long-term control, rather than a guarantee that the scar will vanish entirely. Set against that honest goal, treatment helps a great many people considerably.
Prevention

Preventing keloids if you are prone

If you have formed a keloid before, prevention after any new skin injury is worthwhile:

  • Good wound care after any injury or surgery
  • Early scar-management measures, such as silicone, started once a wound has healed
  • Thinking carefully before elective procedures that break the skin — including piercings — in keloid-prone sites
  • Telling your doctor about your tendency before any planned procedure, so preventive steps can be built in
Seeking help

When to see a dermatologist

Consider an assessment if:

  • A scar is growing, raised, itchy or tender
  • It is spreading beyond the original wound
  • It is restricting movement over a joint
  • It is affecting your confidence
  • You are prone to keloids and are planning a procedure that will break the skin

Earlier treatment of a thickened scar is generally more effective than waiting until it is well established. Our surgical dermatology and laser pages cover related scar treatments.

Dr Chen Qiping, Consultant Dermatologist, Chen Dermatology Singapore

Dr Chen Qiping

Consultant Dermatologist · MBBS, MRCP (UK), M.Sc, FAMS (Dermatology)

Dr Chen practises general and surgical dermatology, including the treatment of keloid and hypertrophic scars, alongside laser and cosmetic dermatology. Consultations are available in English and Mandarin.

Full profile →
Common questions

Keloid scars — frequently asked questions

What is the difference between a keloid and a hypertrophic scar?
Both are raised, thickened scars, but they differ in how they grow. A hypertrophic scar stays within the boundary of the original wound and often improves gradually over time. A keloid grows beyond the edges of the original injury, invading the surrounding normal skin, and does not tend to regress on its own. Keloids are also more likely to recur after removal, which is why they are managed rather than simply cut out.
Why are keloids more common in some people?
There is a clear individual and genetic tendency. Keloids are considerably more common in people with darker skin tones, including many of Asian and African descent, and they often run in families. Certain sites — the earlobes, chest, shoulders and jawline — are also more prone. This is why someone who has formed a keloid before is at higher risk of forming another, and why prevention matters after any skin injury or surgery.
Can keloids be removed completely?
Keloids are challenging precisely because surgery alone frequently leads to recurrence — sometimes larger than before. For this reason they are usually treated with a combination of approaches aimed at flattening, softening and settling the scar rather than a single excision. Realistic expectations are important: the goal is meaningful improvement and symptom relief, and often long-term control, rather than a guarantee of complete disappearance.
Do keloids cause symptoms, or are they just a cosmetic problem?
They can do both. Beyond their appearance, keloids and hypertrophic scars are often itchy, tender or occasionally painful, and a scar over a joint can restrict movement. These symptoms are a legitimate reason to seek treatment, quite apart from how the scar looks. Relief of itch and discomfort is frequently one of the more achievable benefits of treatment.
How can I prevent a keloid if I know I'm prone to them?
If you have formed keloids before, prevention after any new injury, piercing or surgery is worthwhile. Measures such as good wound care, and specific scar-management approaches started early, can reduce the chance and severity of a keloid forming. It is also sensible to think carefully before elective procedures that break the skin — including piercings — in keloid-prone sites. Mentioning your tendency to a doctor before any planned procedure allows preventive steps to be built in.
When should I see a dermatologist about a scar?
Consider assessment if a scar is growing, raised, itchy, tender or restricting movement; if it is spreading beyond the original wound; if it is affecting your confidence; or if you are prone to keloids and are planning a procedure that will break the skin. Earlier treatment of a thickened scar is generally more effective than waiting until it is well established.

References

  1. DermNet. Keloid and hypertrophic scar. dermnetnz.org
  2. American Academy of Dermatology. Keloids: Diagnosis and treatment. aad.org
  3. Betarbet U, Blalock TW. Keloids: A Review of Etiology, Prevention, and Treatment. J Clin Aesthet Dermatol. 2020.

Page last reviewed: 28 July 2026.

Important — This page is general information about a skin condition and is not medical advice. It cannot take the place of an individual consultation, examination and diagnosis. Treatment options, their suitability and their possible side effects should be discussed with a qualified doctor who has assessed your skin. Individual results vary. If you have concerns about your skin, please arrange a consultation.

Troubled by a raised, itchy or growing scar?

Arrange a consultation with Dr Chen Qiping at our Collyer Quay clinic — two minutes' walk from Raffles Place MRT. Consultations available in English and Mandarin.

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