Keloid vs. Hypertrophic Scar: What's the Difference and How Is Each Treated?

After any surgery, injury, or even a minor skin break, it's natural to worry about "keloid" scarring — but many scars that look raised and thick are actually hypertrophic, not keloid, and the two behave quite differently. Knowing which one you're dealing with matters, because the right treatment for one can be the wrong choice for the other.

What Makes a Scar Hypertrophic

A hypertrophic scar is raised, red, and sometimes itchy, but it stays within the boundary of the original wound and tends to soften and flatten on its own over months to a couple of years as it matures.

What Makes a Scar a Keloid

A keloid scar grows beyond the edges of the original wound into surrounding normal skin, doesn't reliably shrink on its own over time, and can keep growing years after the original injury has fully healed.

Why the Distinction Changes Treatment

• Hypertrophic scars often respond well to silicone sheeting or gel, pressure therapy, and time, with surgical revision reserved for scars that don't settle adequately on their own
• Keloids are more likely to need corticosteroid injections to flatten the raised tissue before any surgical option is considered
• Because keloids can recur — sometimes larger than before — surgical excision of a keloid is usually paired with an adjunct treatment afterward, such as injections or radiotherapy in select cases, specifically to reduce that recurrence risk
• Cutting into a keloid without an accompanying recurrence-prevention plan can, in some patients, trigger a larger keloid than the one that was removed

Who Is More Prone to Keloids

Keloid formation runs in families and is more common in certain skin types, and certain body sites — the chest, shoulders, upper back, and earlobes in particular — are more prone to keloid formation than areas like the face, which is one reason facial scars are more often hypertrophic than keloid.

If a scar is still raised, itchy, or spreading months after it should have settled, it's worth having it properly assessed rather than guessing — see the scar revision procedure page for how a mature or problematic scar is evaluated and treated.