What You Must Know Before Laser Keloid Scar Treatment! | [Yonsei Star Dermatology Sinchon]

Keloids are scars where the skin abnormally swells in the healed wound area and spreads beyond the original wound boundaries. If a small wound on your chest or shoulder gradually hardens and reddens over time, the first question that comes to mind is likely, "Is this just a scar, or is it a keloid?" To conclude, scars that spread beyond the wound size and are itchy or painful are highly likely to be keloids, and the sooner treatment begins, the easier management becomes.

If the skin sustains a wound beyond a certain depth, scars are difficult to avoid, though the degree may vary. Usually, during the healing process, a hypertrophic scar forms, slightly raised above the skin. However, in some individuals, due to their constitution, the scar swells much larger than the original wound, which is called a keloid.

Constitutional factors play a significant role in keloids. When combined with the scar's shape, color, thickness, and location, the progression varies, making it known as a difficult-to-treat scar. Although not a malignant tumor like cancer, keloids often become red, itchy, or painful while growing, leading people to seek medical attention. Understanding the characteristics of keloid scars first will make it much easier to determine the future management direction.

Keloids tend to form in areas where the skin is under significant tension. In the clinic, the same pattern is repeatedly observed:

• Areas with high skin tension, such as the chest, shoulders, and upper back
• Jaw areas that move frequently when speaking or eating after acne has passed
• Areas with a history of piercings or trauma, such as earlobes or ear rims

If a wound in these areas gradually increases in size and hardens, a keloid can be suspected. If acne has led to scarring, it is advisable to also consider acne scar management.

Unfortunately, there is no way to determine if you have a keloid constitution from birth based solely on appearance. Usually, it is only after a wound has occurred and the area swells significantly, reddens, and increases in size beyond the original wound that it is recognized as a keloid.

If you have had keloid scars before, it is safer to consider yourself to have a keloid constitution. In this case, it is advisable to avoid unnecessary surgeries or injuries, and if a wound occurs, it is best to start treatment promptly. If you are facing surgery, simply informing the medical staff in advance that you have a keloid constitution can help reduce the possibility of recurrence.

If you are new to keloid management and unsure where to start, please use chat consultation for keloid scars to ask your questions.

Both keloid scars and hypertrophic scars (hypertrophic cicatrix) are scars that swell above the skin surface. However, they differ in the extent to which they spread.

However, keloids and hypertrophic scars are not perfectly distinct, like being cut with a knife. If you have a constitution where scars tend to swell, it is more realistic to consider yourself to have a keloid constitution and prepare in advance. Cosmetic surgery scars or surgical scars that become thick and raised are approached in the same context.

The point at which keloid scars become itchy or painful is usually when the scar is about to grow larger. Therefore, it is advisable to consider treatment if the following signs appear:

• The scar noticeably grows larger in a short period
• The scar area is frequently itchy
• Pain is felt when pressed or brushed
• The color gradually reddens and hardens

The primary treatment method involves direct injection into the scar area. Injections are reported to reduce inflammation and shrink the size of the keloid. Methods such as Triamcinolone Scar Injection will be applied step-by-step depending on the symptoms, area, and progression. However, keloids are heavily influenced by constitutional factors and individual differences may exist, so it is better to understand it as a process of continuous management, observing the progress rather than expecting a single treatment to suffice.

Once a keloid is established, management takes time, so prevention and early intervention are crucial. If you have a history of keloids, be careful not to create unnecessary piercings or wounds, and if even a small wound swells differently than usual, do not neglect it and seek early medical attention.

Sang-Joo Lee, Chief Director (MD, PhD, Yonsei University College of Medicine and Graduate School; Dermatology Resident, Severance Hospital; President, Korean Society for Dermatology) Chief Director Sang-Joo Lee's Profile First Published 2023-12-22 / Last Reviewed 2026-06-16

This content is for general information purposes only, and outcomes may vary depending on individual constitution and condition. Accurate diagnosis and treatment should be determined through consultation with medical professionals.