Insights ·
Keloids Explained: Why They Form and How We Treat Them
What keloids are, who is most at risk, and the treatment options available in South Africa — from early scar care through to surgery and radiotherapy.
Every wound heals by laying down scar tissue — that is simply how skin repairs itself. Most scars fade over months into a thin, pale line. Some become raised, red and itchy for a while before settling within a year.
But for some patients something different happens. The scar tissue keeps growing, spreads beyond the edges of the original injury, and never fully resolves on its own.
That is a keloid.
I discussed this recently on 702’s The Masterclass with Relebogile Mabotja, and given how many questions came in during the segment, I wanted to set out the key points here — for anyone living with keloids, or wondering whether what they are seeing on their skin is one.
What makes a keloid different from an ordinary scar
Normal healing follows an orderly process. The body lays down scar tissue in a controlled way, confined to the site of injury. A hypertrophic scar is raised, firm and itchy, but it stays within the boundaries of the wound and gradually improves over roughly a year.
A keloid behaves quite differently. The cells responsible for laying down scar tissue — fibroblasts — don’t follow that orderly pattern. The tissue grows in a chaotic, unstructured way that extends well beyond the original wound, sometimes years after the initial injury.
Left alone, keloids do not shrink or disappear. They need active treatment.
The reassuring part is that keloids are not cancerous, and they carry no risk of becoming cancerous. But that does not make them trivial. They can be physically uncomfortable and genuinely distressing to live with.
Why some people get them and others don’t
Keloid formation has a strong genetic component. If your parents have had keloids, your own risk is meaningfully higher — though there is currently no genetic test that can confirm this in advance.
Skin tone plays a role too. People with black, Asian or Indian skin are more prone to keloids, in much the same way that people with fair skin are more prone to certain skin cancers. It comes down to genetics.
There is no way to prevent keloids outright if you are predisposed to them, but knowing your risk matters. If keloids run in your family, it is worth being cautious about elective skin trauma — piercings, tattoos and similar procedures — and making sure whoever performs them is working in a properly sterile environment. Infection and prolonged irritation in a wound are known triggers.
Where they typically appear
Keloids can form anywhere you have skin, but certain sites come up again and again:
- Earlobes, especially after piercings
- The beard and hairline area, from shaving or ingrown hairs
- The chest, back and shoulders
- Injection and vaccination sites
Areas under a lot of movement or tension tend to be more prone, which is part of why chest and shoulder keloids can be particularly stubborn.
A useful rule of thumb: if a scar looks wider or more raised than the injury that caused it, and it has not settled over time, it is worth having it assessed rather than assuming it will resolve on its own.
Living with a keloid
The itching is often the hardest part to describe to someone who has not experienced it — intense, sometimes near-constant, and made worse by scratching, which causes further irritation and can encourage even more scar tissue to form.
Beyond the physical discomfort, keloids can affect confidence and social comfort in ways that are easy to underestimate from the outside.
Why keloids keep coming back
This is one of the most frustrating aspects for patients: cutting a keloid out is not, by itself, a lasting solution.
The incision is a new wound. In someone prone to keloids, that new wound can produce another keloid — often larger than the first. Simply re-excising a keloid again and again tends to make the problem worse over time.
This is why the plan around the surgery matters as much as the surgery itself.
Treatment: what works, and in what order
Treatment generally moves from least to most invasive.
Conservative care
Early and small keloids often respond to conservative measures — keeping the area clean and well hydrated, silicone tape or sheeting over the scar, and vitamin A or E based creams used to massage and flatten it.
Steroid injections
Once a keloid is more established, steroid injections are a mainstay. They target the overactive scar-forming cells directly, and they also help control the itch.
Timing matters here. I track with each patient how long the itch relief lasts after an injection, so treatments can be spaced to stay ahead of it rather than reacting to flare-ups.
Surgical excision
Where surgery is needed, it has to be paired with a deliberate postoperative plan — steroid injections around the time of surgery, compression dressings, and careful, gentle tissue handling during the procedure itself — to reduce the chance of a new keloid forming at the fresh wound site.
For visible areas such as the face, planning the excision and the closure to preserve the person’s natural features matters just as much as removing the keloid. This overlaps closely with scar revision more generally.
Radiotherapy
Radiotherapy is reserved for more resistant cases. It works by stopping fast-growing cells from proliferating.
Because it is a treatment more commonly associated with cancer care, it carries its own long-term risk of skin cancer at the treated site. That makes it a decision taken carefully, weighing the risk against the benefit, and generally only after less invasive options have failed to hold.
There is currently no cure that removes the underlying genetic tendency. The goal of treatment is to manage it as effectively as possible and reduce the chance of recurrence — not to promise it will never come back.
When to see a specialist
If you notice a scar that keeps growing beyond the original wound, does not settle after several months, or is increasingly itchy, painful or affecting your confidence, start with your GP, who can refer you to a plastic surgeon.
The earlier a keloid is properly assessed and treated, the better the outcome tends to be. Waiting until it is very large usually means a bigger procedure is needed to remove it and repair the area.
You can read more about how we approach this in keloid management, and about scars in general in our article on scar management.
Listen to the full conversation
I covered this in more depth, including questions from callers, on 702’s The Masterclass with Relebogile Mabotja.
If you are dealing with a keloid, or are unsure whether a scar might become one, book a consultation to have it properly assessed.