Keloid vs Hypertrophic Scars: How to Tell the Difference

Raised scars fall into two main groups: hypertrophic scars and keloids. They can look similar at first glance, but they behave differently and respond to different treatments. Knowing which one you have is the first step in choosing the right approach.

The key difference

A hypertrophic scar stays within the boundaries of the original wound. It is raised, often red or pink, and it usually improves slowly over months to a couple of years. A keloid grows beyond the edges of the original injury, spreading into surrounding healthy skin. Keloids rarely settle on their own and have a strong tendency to come back after treatment.

How each one forms

Both scars are the result of the body producing too much collagen during healing. In hypertrophic scars this over-production is limited and tends to calm down. In keloids the process continues unchecked, which is why a keloid can keep enlarging long after the wound has closed. Keloids are more common in people with darker skin tones and often run in families.

Where they tend to appear

• Hypertrophic scars: anywhere a wound is under tension — across joints, the chest, or a surgical incision that was pulled tight.
• Keloids: most often on the earlobes (after piercing), shoulders, upper chest, and upper back.

Treatment differences

Hypertrophic scars often respond well to conservative measures: silicone therapy, pressure, and corticosteroid injections. Many soften considerably without surgery.

Keloids are more stubborn. Surgery alone is usually a mistake, because cutting out a keloid can trigger an even larger one. That is why keloid treatment is almost always combined — for example, careful surgical removal followed by a planned course of steroid injections, pressure, and sometimes radiotherapy or other adjuncts to reduce the chance of recurrence.

When to seek assessment

If a raised scar is growing, itching, painful, or affecting how you feel, it is worth having it evaluated. A tailored plan — matched to the scar type, your skin, and the location — gives the best chance of a lasting improvement.