We Ask a Derm: How Do I Get Rid of a Keloid Scar?

I never knew what a keloid (pronounced “kee-loyd”) was or that I was prone to getting them until I had surgery in 2017. While the stitches dissolved in days and the bruising around the area disappeared shortly thereafter, a large and shiny raised scar still remains years later.

I suspect there are many others who also have keloids (including our girl, Padma Lakshmi, who proudly wears a seven-inch scar on her arm that’s not unlike the one on my leg). So for the people who have keloids—old or new—and are wondering what to do about them, I asked Dr. Melissa Kanchanapoomi Levin, M.D., a board-certified dermatologist and founder of Entière Dermatology in New York for some intel on what they are, what causes them and the best ways to treat them.

“When it comes to scars, you can pretty much sort them into two main categories: those that have too much collagen, which are known as hypertrophic scars, and those that don’t have enough collagen or atrophic scars,” explains Levin.

Common examples of atrophic scars include boxcar, rolling or ice pick scars, which often result from long-term inflammatory or cystic acne. The best way to describe them is indented or depressed, as in they have a sunken or pitted appearance.

In contrast, a hypertrophic scar is often raised and bumpy—as is a keloid. “The main difference between a hypertrophic scar and a keloid is that a hypertrophic scar doesn’t extend beyond the area of injury,” says Levin. “Keloids are larger and grow beyond the borders of the original site of trauma.”

Though hypertrophic scars and keloids can occur anywhere, “they are most likely to form in areas of high tension like your chest, neck and back and on your ear lobes,” Levin says.

“Both hypertrophic scars and keloids tend to occur more in the second and third decades of life and are more common in skin of color,” says Levin. (Check and check.) “There is also a genetic component to it, so if you are prone to getting keloids, chances are your relatives are, too, and vice-versa.” (Thanks, Mom and Dad.) 

We’re not going to sugarcoat it: Keloids are very tricky to treat. “With these types of scars, their appearance can be improved anywhere between 20 and 80 percent, which is a wide range and there’s no guarantee that the keloid won’t come back or, in some cases, worsen, especially when they’re not monitored afterwards,” Levin tells us.

That is why it’s especially important to see a board-certified dermatologist (or plastic surgeon) when looking into treatment options. “There is a lot of pre- and post- care involved with keloids and hypertrophic scars,” says Levin. “And you’ll likely need multiple treatments over the course of several months, so I always tell my patients upfront that it’s going to take some time and patience.”

Another thing: There isn’t one best treatment for keloids, and in most cases your doctor will use a combination of different treatments to address them, which we’ll get into below. 

The first—and easiest—method you can try at home is a silicone gel or dressing. (Dr. Levin likes Serica Moisturizing Scar Formula, which is a topical gel you can get at drugstores.) The key with either a silicone gel or dressing is to apply them regularly (daily), continuously (for months) and early on (when your scars are new).

Your dermatologist may also recommend other topical treatments. “There are steroids, retinoids, and topical immunodulatory medications like imiquimod, which was traditionally prescribed to treat warts, that can also be used to prevent keloids after surgery,” explains Levin. 

Another option is an intralesional corticosteroid injection, which is used to soften and flatten the scar by breaking up the bonds between collagen fibers and reducing inflammation in the area. According to Levin, “this is typically done over several sessions and sometimes combined with other therapies like 5-fluoroucil injections, which can deliver better results without some of the side effects that may occur with repeated corticosteroid injections like tissue atrophy.”

If your keloid is larger in size or hasn’t responded to the above treatments, you can consider an excision to surgically remove the scar before it is carefully re-healed under the supervision of your derm. “The recurrence rate for keloids is very high, so it’s important to have someone manage the healing process from start to finish,” cautions Levin. “By surgically removing the scar, you’re intentionally inducing trauma to your skin, but also shortening and controlling the healing process. This can include corticosteroid injections in the months following the procedure to prevent recurrence of the keloid.”

Though I wish there was a simple, fool-proof way to get rid of keloids for good, the truth is that they are challenging to treat, and you always run the risk of them coming back. The good news is that they’re harmless and usually painless, but if they’re causing you discomfort or really bother you, talk to a dermatologist to come up with the safest plan for treatment.

Recently, I was at the doctor’s office for a checkup and the nurse noticed the large keloid on my right thigh. I explained that it was from a previous surgery, and she smiled and said, “You know, I like to think of these scars as a sign that your body is working extra hard at protecting you. It’s not a sign of something being broken or wrong. It’s a sign that it’s working extremely well.” Now I don’t think there’s any science to that sentiment, but it was a nice change in perspective.