Flat/Pale Scars: The most common type. Initially pink or red, they gradually fade to a pale, flat mark over 1–2 years. Most surgical scars fall into this category.

Hypertrophic Scars: Raised, red, and firm scars that remain within the boundary of the original wound. They may improve on their own over time (often over 12–18 months).

Atrophic Scars: Sunken or "pitted" scars, common after acne or chickenpox, where tissue has been lost rather than overproduced.

Contracture Scars: Often result from burns; the skin tightens and contracts, potentially affecting movement if over a joint.

Keloid Scars: Raised scars that grow beyond the original wound boundary. These do not resolve on their own and are the focus below.

Keloids are significantly more common in:

• People with darker skin tones (10–15× more prevalent in people of African, Hispanic, and Asian descent)

• Those with a family history of keloids (there is a clear genetic component)

• People aged 10–30 years (less common in the very young or elderly)

• Areas of high skin tension: chest, shoulders, upper back, earlobes, and jaw

Anyone can develop a keloid, but the above factors substantially increase risk.

Corticosteroid Injections

• Most widely used first-line treatment

• Triamcinolone acetonide injected directly into the scar

• Reduces inflammation, flattens, and softens the keloid

• Typically given every 4–6 weeks for several sessions

• Effectiveness: ~50–80% show improvement; recurrence is possible

• Side effects: Skin thinning (atrophy), depigmentation (lightening of skin around injection site), pain during injection, telangiectasia (visible small vessels)

Silicone Gel Sheets / Gels

• Applied directly to the scar daily (usually 12+ hours/day for 3–6 months)

• Hydrates the scar tissue and may reduce collagen overproduction

• Best evidence for prevention and early/flat scars; modest effect on established keloids

• Very safe; suitable as a standalone or adjunct treatment

• Available over the counter

Surgical Excision

• Physical removal of the scar tissue

• High recurrence rate (45–100%) when used alone: keloids frequently return larger after surgery

• Usually combined with other treatments (radiotherapy, steroid injections) immediately post-surgery to reduce recurrence

• Reserved for large or functionally limiting keloids

See your GP if:

• A scar is growing beyond the original wound boundary

• A scar is causing significant pain, itch, or restricted movement

• A scar is affecting your mental health or quality of life

• You are unsure whether a lesion is a keloid or something else

Some scars may require a referral to a plastic surgeon for surgical treatment.