Everyday skin
Scars and keloids
A scar is the permanent patch of skin your body makes when it heals a wound. Most scars fade and soften over time, but some heal raised, sunken, or much larger than the original injury, as with keloids.
Reviewed by Raashid Haque, MD, board-certified dermatologist
For education only. This guide does not diagnose or treat any condition.
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Silicone is a first-line, low-risk option for raised and thick scars.
Look for
- Silicone gel that dries into a thin clear layer
- Thin self-adhesive silicone sheets that can be washed and reused
- Fragrance-free formulas
Full details, cautions and sourcesAvoid
- Putting it on open, weeping, or infected wounds
- Wearing the same sheet on the same spot without breaks if skin gets red or raw
- Expecting an old, flat scar to change a lot
These are products Dr. Haque has reviewed and recommends for different reasons. Unless a product is clearly marked 'Affiliate link,' it is not one. Most are not.
Food and lifestyle may play a part in Scars and keloids too
Anti-inflammatory eating and lifestyleLearn about Scars and keloids
A scar forms when the deeper layer of skin is injured by a cut, burn, surgery, piercing, infection, or acne. The body fills the gap with collagen, which looks and feels a little different from normal skin.
Normal healing. A new scar is often pink, red, or purple on lighter skin, and darker brown or purple on brown and Black skin. Over many months it usually flattens, softens, and fades. This can take a year or two, sometimes longer. Scars fade but do not disappear.
Common types
- Flat or fine-line scars: thin and level with the skin.
- Atrophic scars: sunken, often from acne. They can look like small pits, boxes, or gentle waves.
- Hypertrophic scars: raised and firm, but they stay inside the edges of the original wound. They often calm down slowly over time.
- Keloids: raised, firm, shiny growths that grow beyond the edges of the wound. They can keep growing for months or years and do not fade on their own.
Keloids are more common in people with darker skin, including Black people and people of Asian, Latin American, or Mediterranean background. Many people with keloids have a close relative who gets them. They often appear on the earlobes, chest, and shoulders, and after piercings.
Scars are not contagious. Keloids are not cancer. Flat brown or red marks left after a pimple are often color changes, not true scars, and they may fade by themselves.
Self-care
What it is
Keeping a new wound clean and covered, leaving scabs alone, and shielding the healing area from the sun.
Often considered when
Any new cut, surgery, piercing, or burn, and especially for people who know they scar easily.
Less suitable or needs caution when
Not a substitute for care if a wound looks infected, is very deep, or will not close.
What to watch for
Signs of infection, a wound that stays open, or skin that starts to thicken. Some people react to bandage adhesives or ointments.
How long to judge it
Wounds often take days to a few weeks to close, and scars keep maturing for a year or longer.
Questions to ask
- Is this wound likely to scar, and does it need stitches or special care?
- Given my family history, what should I watch for as it heals?
- What kind of sun protection is best for a healing scar on my skin tone?
What it is
Massaging a fully healed scar with a bland moisturizer, or using pressure items such as pressure earrings or garments, to help keep it flatter.
Often considered when
Massage is often suggested for healed, stiff, or tight scars. Pressure is often discussed for earlobe keloids or after keloid treatment.
Less suitable or needs caution when
Not for wounds that are still open or healing. Pressure devices can be uncomfortable and are hard to wear consistently.
What to watch for
Pain, skin breakdown, or a scar that gets more irritated. Honest note: evidence for massage is limited, and pressure only helps if it is worn consistently.
How long to judge it
Often judged over several months.
Questions to ask
- Is my scar healed enough for massage?
- Would a pressure device make sense for my location?
- How will we know if either is helping?
Over the counter
What it is
Soft silicone sheets or gels placed on a healed scar that may help keep it flatter and softer.
Often considered when
After a wound has closed, for people at higher risk of raised scars, or for scars that are red, thick, or itchy.
Less suitable or needs caution when
Not for open or infected wounds. Sheets can irritate or cause rash in some people, and may be hard to use on the face or in moving areas.
What to watch for
Skin irritation, rash, or moisture trapped under a sheet. Honest note: reviews of silicone find the research is often low quality, so the benefit is uncertain even though it is widely used.
How long to judge it
Clinicians often judge it over a few months, since scars change slowly.
Questions to ask
- Is silicone reasonable for my kind of scar, or is it unlikely to help?
- Sheet or gel: which fits the area where my scar is?
- When should I decide it is not working and move on?
Procedures
What it is
A clinician injects a corticosteroid medicine directly into a raised scar to help it shrink and soften. It is one of the most commonly used treatments for keloids and hypertrophic scars.
Often considered when
A scar is raised, thick, itchy, or tender. Often repeated visits are needed.
Less suitable or needs caution when
Less suitable with an infection in the area. Pregnancy and other medical conditions should be discussed with the doctor.
What to watch for
Thinning or a dent in the skin, lightening of the skin (more noticeable on brown and Black skin), visible small blood vessels, and pain at the injection. The AAD notes many keloids shrink with injections, but many grow back over time.
How long to judge it
Often judged after several treatment visits spread over months.
Questions to ask
- Is an injection reasonable for my scar?
- What are the chances of skin lightening or a dent in my skin tone?
- If it grows back, what is the next step?
What it is
Freezing a raised scar to help flatten it. For keloids, some clinicians freeze from the inside.
Often considered when
Smaller raised scars or keloids, sometimes before or alongside injections.
Less suitable or needs caution when
The AAD notes it is often not recommended for darker skin tones because of the risk of lasting light spots. Also less suitable for large scars.
What to watch for
Blistering, pain, lasting lightening of the skin, and scars that return.
How long to judge it
Usually judged over several visits and months.
Questions to ask
- Is freezing a good option for my skin tone?
- What is the chance of light spots?
- Would you combine it with another treatment?
What it is
Different lasers can reduce redness in a scar, flatten a raised scar, or smooth the surface of a pitted one. Clinicians often use them together with other treatments.
Often considered when
Red or raised scars, or textured acne scars, after a skin exam.
Less suitable or needs caution when
Caution with brown and Black skin and with a recent tan: some lasers can cause dark spots, light spots, or even worse scarring. The device and settings must be matched to the skin. Not for infected or open skin.
What to watch for
Temporary redness, swelling, crusting, color changes, and sometimes a worse scar. Ask whether the person treating you has experience with your skin tone.
How long to judge it
Often needs several sessions, and results are judged over months.
Questions to ask
- Which laser is safest for my skin tone, and what are the risks?
- Should I avoid sun or tanning before and after?
- How many sessions might be discussed?
What it is
Microneedling uses tiny needles to prompt the skin to rebuild collagen. Other options for sunken acne scars include chemical peels, subcision (releasing the scar from below), fillers, and punch techniques for deeper pits.
Often considered when
Atrophic (sunken) acne scars once the acne is under control. Different scar shapes respond to different methods, so clinicians often combine them.
Less suitable or needs caution when
Not over active acne, infection, or a cold sore. Less suitable with a history of keloids, since any injury might cause a raised scar. Peels and needling can darken skin in brown and Black skin if not done carefully.
What to watch for
Redness, swelling, bruising, dark spots, and rarely infection or a raised scar. Results are usually partial, not complete.
How long to judge it
Usually several sessions, judged over months.
Questions to ask
- What kind of acne scars do I have and which method suits them?
- Is it safe for me given my skin tone and keloid risk?
- What improvement is realistic?
What it is
A surgeon removes a scar or reshapes it so it heals in a less noticeable way.
Often considered when
A scar is very large, bothersome, restricts movement, or other treatments have not helped.
Less suitable or needs caution when
For keloids, surgery alone often leads to regrowth, sometimes a larger keloid, so it is usually paired with other treatments. Discuss risks if you have a history of keloids or poor wound healing.
What to watch for
Infection, wound opening, a new scar that is as bad or worse, and, for keloids, a high chance of coming back. The AAD notes keloids very often return after surgery alone.
How long to judge it
The new scar matures over a year or more.
Questions to ask
- Would surgery make sense for my scar, or could it make it worse?
- What would be done to lower the chance of regrowth?
- What does recovery look like?
What it is
Low-dose radiation given right after a keloid is removed, to lower the chance it comes back. It has been used for many years.
Often considered when
Stubborn or large keloids that keep returning after other treatments, usually discussed with a specialist.
Less suitable or needs caution when
Often avoided in children, in pregnancy, and over areas sensitive to radiation. Many clinicians are cautious about it, so it is usually not a first choice.
What to watch for
Skin irritation and color change. The AAD notes a possible long-term cancer risk, which is why the decision is made carefully with a specialist.
How long to judge it
The treatment itself is short, but whether it worked is judged over many months to years.
Questions to ask
- Why might radiation be discussed for my keloid?
- What are the risks for the area where my keloid is?
- What other options are there first?
Scars and keloids start with some kind of skin injury. Things that may raise the chance of a raised scar include:
- Family history or darker skin tone, which are the strongest known risk factors for keloids.
- Piercings, especially in the ear, and sometimes tattoos.
- Acne, especially deep, painful, or picked acne, which raises the chance of acne scars.
- Surgery or wounds on the chest, shoulders, upper back, or earlobes, where keloids are more common.
- Wounds under tension or that heal slowly, such as an infected wound or one over a joint.
- Picking or scratching a healing wound.
- Sun on a fresh scar, which can make it darker and more noticeable.
Keloids can sometimes appear without a wound anyone remembers, from a tiny injury such as an insect bite or a pimple.
| Topic | Evidence | What it means |
|---|---|---|
| Onion extract and vitamin E products | Early | Many people try onion extract gels or vitamin E oil. Reviews find the evidence for onion extract is low and inconsistent, and vitamin E has shown no clear benefit in trials. Vitamin E can also cause skin rashes in some people. |
| Sun protection on a healing scar | Promising | Sun can make new scars darker and more noticeable, especially on brown and Black skin. Covering the scar or using sunscreen is widely advised. Good trials specifically on scars are limited. |
| Smoking and wound healing | Established | Smoking is known to slow wound healing and raise the risk of wound problems after surgery. Stopping before a planned procedure may help your skin heal better. |
| Not picking and early acne care | Established | Picking at pimples and scabs increases inflammation and the chance of scarring. Getting acne treated early, before it becomes deep or painful, is a common way to lower the risk of acne scars. |
Read: Anti-inflammatory eating
Avoid very restrictive diets, especially for children, unless a clinician is guiding you.
Scars and keloids ·
When to get care soon
- A wound that is not healing, keeps opening, or has not closed after a few weeks.
- Signs of infection in a wound or piercing: spreading redness or warmth, swelling, pus, a bad smell, increasing pain, or fever.
- A scar or lump that is growing quickly or keeps growing past the edge of the original wound.
- A scar that is very painful, very itchy, or limits movement of a joint, eyelid, or mouth.
- A scar that changes, bleeds, forms an open sore, or develops a crust years after it healed. Rarely, skin cancer can develop in an old scar.
- A new firm bump on a piercing or surgical scar that is getting thicker.
- Redness is harder to see on brown and Black skin, so look for warmth, swelling, tenderness, and darkening instead of color alone.
About the reviewer
Raashid Haque, MD
Board Certified Dermatologist · Charlotte, NC
- 25+ years of clinical experience
- Dermatology at University of Oklahoma - Chief Resident
- Internship at Baylor College of Medicine
- LSU School of Medicine Shreveport - Valedictorian, AOA