Specialist Treatment for Complex, Raised and Irritated Scars
Keloid scars are one of the most complex types of scars to treat. They are not simply “thick scars”. They are caused by an overactive healing response where the body continues to produce excess scar tissue even after the original wound has healed.
At Skin and Scar Care Clinic, we offer a personalised approach to keloid management using a combination of treatments such as cryotherapy, Long-Pulsed Nd laser, CO₂ laser, CO₂ laser with cryotherapy, laser-assisted drug delivery, and steroid injections.
The aim of treatment is to improve the scar, reduce symptoms, flatten the raised tissue, soften the scar, reduce redness and irritation, and help stop further growth or relapse.
Keloids cannot be guaranteed to disappear completely, and they cannot be “cured” in the same way as a simple skin condition. However, with the right combination of treatments, many patients can achieve meaningful improvement in comfort, appearance, thickness, redness, and scar behaviour.
What Is a Keloid Scar?
A keloid is a raised scar that grows beyond the boundary of the original injury. It may continue to enlarge over time and can become firm, thick, itchy, painful, red, dark, shiny, or sensitive.
Keloids may develop after:
- Surgery
- Piercing
- Acne
- Burns
- Cuts or trauma
- Injections
- Tattoos
- Vaccination marks
- Minor skin injury
- Infection or inflammation
Some keloids appear after very small injuries, and some develop without the patient remembering any clear trauma.
Why Are Keloids So Difficult to Treat?
Keloids behave differently from normal scars. In normal wound healing, the body produces collagen to repair the skin and then gradually slows down the repair process.
In keloid-prone skin, this process becomes overactive. The scar continues to produce excess collagen and blood supply, causing the scar to become raised, thick, red, itchy, painful, or wider than the original injury.
This is why keloids often need a combination approach rather than one single treatment.
The main challenges with keloid scars are:
- They can continue to grow
- They can relapse after treatment
- They may become itchy, painful, or irritated
- They can become red, dark, or inflamed
- They may become wider and thicker over time
- Surgery alone can sometimes make them worse
- Different body areas respond differently
- Several sessions are usually required
The goal is not only to improve the appearance of the scar, but also to control its activity.
Common Symptoms of Keloids
Keloid scars may cause:
- Raised or thick scar tissue
- Itching
- Pain or tenderness
- Redness or increased colour
- Burning or irritation
- Tightness
- Sensitivity to touch
- Cosmetic concern
- Continued growth
- Recurrent inflammation
- Restriction of movement in some areas
Many patients seek treatment because the scar is uncomfortable, catches on clothing, becomes irritated, or continues to grow.
Keloid vs Hypertrophic Scar
Keloids and hypertrophic scars are both raised scars, but they behave differently.
A hypertrophic scar usually stays within the boundary of the original wound. It may improve slowly over time and often responds better to treatment.
A keloid scar grows beyond the original wound edges and may continue to enlarge. Keloids are more likely to relapse and usually require a more careful, long-term treatment plan.
Treatment Options for Keloids
1. Cryotherapy
Cryotherapy involves freezing the keloid scar using controlled cold treatment. This can help damage the overactive scar tissue and reduce the size, height, and activity of the keloid.
Cryotherapy can be useful for:
- Smaller keloids
- Firm raised scars
- Active irritated scars
- Scars that need softening before injection
- Keloids that are difficult to inject directly
- Cryotherapy is often combined with steroid injections because freezing the scar can make the tissue softer and easier to treat.
What to Expect
After cryotherapy, the area may become swollen, tender, blistered, darker, lighter, or crusted before healing. This is part of the controlled healing response.
Patients with darker skin tones may have a higher risk of temporary or long-term pigmentation change, so treatment settings and suitability must be assessed carefully.
2. Long-Pulsed Nd Laser
Long-Pulsed Nd laser can be used to target the vascular and inflammatory component of keloid scars.
Many active keloids have increased blood supply, redness, heat, irritation, or sensitivity. By targeting the deeper vascular component, Nd laser may help reduce redness, inflammation, discomfort, and ongoing scar activity.
Long-Pulsed Nd laser may help with:
- Red or vascular keloids
- Irritated scars
- Thick scars with increased blood supply
- Itching and sensitivity
- Reducing scar activity
- Supporting longer-term scar control
This treatment is often used as part of a combined protocol with cryotherapy, CO₂ laser, or steroid-based treatments.
3. CO₂ Laser
CO₂ laser is an advanced resurfacing laser that can be used to reduce the bulk, thickness, and irregular surface of selected keloid or hypertrophic scars.
In keloid management, CO₂ laser may be used carefully to:
- Resurface raised scar tissue
- Reduce scar height
- Improve texture
- Create controlled channels for medication delivery
- Improve the surface of thick or irregular scars
- Support better penetration of medication
CO₂ laser is not usually used as a standalone cure for keloids. It is often combined with other treatments to reduce the risk of relapse.
4. CO₂ Laser and Cryotherapy Combination
For selected keloids, a combination of CO₂ laser and cryotherapy may be recommended.
This approach is useful when the scar is raised, thick, firm, or resistant to simple treatment. CO₂ laser helps reduce the surface bulk and texture, while cryotherapy helps control the deeper overactive scar tissue.
The combination may help:
- Flatten thick scars
- Reduce the height of the keloid
- Improve the surface texture
- Reduce scar activity
- Improve medication penetration
- Reduce irritation and inflammation
- Support longer-term scar control
This combination is especially helpful when one treatment alone is unlikely to be enough.
5. Laser-Assisted Drug Delivery (Including Steroids)
Laser-assisted drug delivery uses fractional CO₂ laser to create microscopic channels in the scar, allowing medication such as steroid solutions to penetrate more effectively into the deeper layers of the keloid.
This technique may help:
- Improve delivery of steroid medication into dense scar tissue
- Enhance the effectiveness of treatment
- Reduce scar thickness and firmness
- Improve texture and surface irregularity
- Support better long-term scar control
Laser-assisted drug delivery can be particularly useful for thicker or resistant keloids where injections alone may be difficult or less effective.
6. Silicone Gel and Scar Care
Silicone gel or silicone sheets may be recommended as part of ongoing scar management. Silicone can help hydrate the scar, reduce irritation, and support scar maturation.
It is usually most helpful when used consistently over several months.
Silicone may be advised:
- After laser treatment
- Between treatment sessions
- For early or active scars
- To reduce friction and irritation
- As part of long-term maintenance
7. Steroid Injections
Steroid injections are one of the most commonly used treatments for keloid scars.
A small amount of steroid medication is injected directly into the scar. This helps reduce inflammation, slow down excess collagen production, soften the scar, and gradually flatten the raised tissue.
Steroid injections may help with:
- Raised scar height
- Itching
- Pain
- Redness and irritation
- Scar firmness
- Ongoing scar activity
Several sessions are usually required. Steroid injections may be used alone or combined with cryotherapy, CO₂ laser, or laser-assisted drug delivery depending on the scar type.
Possible Side Effects
Steroid injections are generally well tolerated, but possible side effects include skin thinning, lightening of the skin, small visible blood vessels, dimpling, temporary discomfort, or reduced pigmentation in the treated area.
Why Combination Treatment Works Better
Keloids are complex because they have different components:
- Excess collagen
- Increased scar thickness
- Inflammation
- Increased blood supply
- Surface irregularity
- Itching and pain
- Risk of relapse
One treatment may improve one part of the scar, but not all of it.
For example:
- Cryotherapy helps shrink and soften scar tissue
- Nd laser helps target vascular activity and redness
- CO₂ laser helps reduce surface thickness and improve texture
- Laser-assisted drug delivery improves medication penetration
- Steroid injections help reduce inflammation and scar activity
- Silicone helps support scar control between sessions
This is why a combined treatment plan is often more effective than a single treatment.
Treatment Timeline
Typical Treatment Course
Most patients require a course of:
4–6 sessions
Sessions are usually spaced:
4–6 weeks apart
Some active or resistant keloids may require a longer course.
Example Treatment Journey
Consultation and Assessment
Your scar will be assessed carefully to understand whether it is a keloid, hypertrophic scar, active scar, mature scar, or mixed scar.
We will assess:
- Scar thickness
- Colour and redness
- Symptoms such as itching or pain
- Scar age
- Scar location
- Skin type
- Previous treatment history
- Risk of pigmentation change
- Risk of recurrence
A personalised treatment plan will then be recommended.
Session 1: Test Patch or First Treatment
Depending on the scar and your skin type, we may start with a small test patch or a conservative first session.
This may include:
- Cryotherapy
- Nd laser
- CO₂ laser
- Laser-assisted drug delivery
- Steroid injection
- Combination treatment
The aim is to check how the scar responds and reduce early activity.
Sessions 2–3: Scar Activity Control
At this stage, treatment focuses on reducing:
- Itching
- Pain
- Redness
- Raised thickness
- Firmness
- Ongoing growth
Combination treatment may be adjusted depending on response.
Sessions 4–6: Flattening and Refinement
Later sessions focus on improving:
- Scar height
- Texture
- Contour
- Colour
- Surface smoothness
- Long-term stability
Some scars may need maintenance sessions to reduce the chance of relapse.
Maintenance and Relapse Prevention
Keloids have a tendency to return, especially if they are active, large, genetically prone, or located in high-risk areas such as the chest, shoulders, jawline, ears, upper back, or breast area.
Maintenance may include:
- Silicone gel or sheets
- Avoiding friction
- Avoiding unnecessary trauma or piercings
- Sun protection
- Early review if the scar starts itching again
- Repeat steroid injection or laser if early relapse occurs
- Follow-up sessions every few months if needed
Early treatment of relapse is usually easier than treating a large, mature keloid.
What Results Can You Expect?
Keloid treatment aims to improve the scar rather than remove it completely.
The expected improvements may include:
- Reduced itching
- Reduced pain
- Reduced redness
- Reduced irritation
- Softer scar texture
- Flatter scar height
- Reduced growth activity
- Improved surface texture
- Improved comfort
- Better cosmetic appearance
It is important to understand that keloids cannot be guaranteed to disappear completely. The aim is to control the scar, improve symptoms, reduce height, and help prevent further growth or relapse.
Frequently Asked Questions
No. Keloids cannot be reliably cured. Treatment can improve their appearance, reduce symptoms, flatten the scar, and help stop further growth, but relapse can occur.
Laser-assisted drug delivery uses fractional laser to create microchannels in the scar, allowing medications such as steroids to penetrate deeper and work more effectively within dense scar tissue.
CO₂ laser helps improve the surface and thickness of the scar, while cryotherapy helps shrink and control deeper scar tissue. Together, they may give better results in selected thick or resistant keloids.
Some treatments can be uncomfortable, especially injections or cryotherapy. We aim to make treatment as comfortable as possible and may use cooling, local anaesthetic, or numbing cream depending on the treatment.
Most patients need 4–6 sessions, but some scars require more. Resistant, large, old, or recurrent keloids usually need longer treatment.
Sessions are commonly spaced 4–6 weeks apart, depending on the treatment used and how the scar responds.
Yes. Surgery alone can trigger a new or larger keloid in some patients. If surgical removal is considered, it is usually combined with other treatments to reduce recurrence risk.
If you are prone to keloids, prevention is very important. Avoid unnecessary piercings, tattoos, or skin trauma where possible. Early scar care, silicone gel, sun protection and early treatment may reduce risk.
Keloids are usually harmless and non-cancerous, but they can be uncomfortable, itchy, painful, cosmetically distressing, or functionally restrictive.
Yes, but treatment must be planned carefully. Darker skin types can have a higher risk of pigmentation changes after laser or cryotherapy, so settings and treatment choice must be tailored.
Temporary colour change can happen after steroid injection, cryotherapy or laser. Some patients may develop lighter or darker pigmentation, especially in darker skin types. This will be discussed during consultation.
Yes. Older keloids can be treated, but they are often firmer and may need more sessions than newer scars.
Yes. Keloids from surgery, piercings, acne, trauma or inflammation can often be improved, but the treatment plan depends on the location, thickness, symptoms and skin type.
Safety and Medical Disclaimer
Keloid treatment is a medical-aesthetic treatment and is subject to consultation, assessment, suitability, and informed consent.
Keloids are complex scars and cannot be guaranteed to be cured or permanently removed. The aim of treatment is to improve symptoms, reduce itching and pain, flatten the scar, improve colour and texture, slow or stop further growth, and reduce the risk of relapse.
Relapse can occur even after successful treatment. Some keloids may require repeated sessions, maintenance treatment, or long-term monitoring.
Possible side effects of treatment may include temporary pain, redness, swelling, bruising, blistering, crusting, infection, delayed healing, pigmentation changes, skin thinning, visible small blood vessels, scarring, recurrence, or incomplete improvement.
Patients with darker skin tones may have a higher risk of post-treatment pigmentation changes, particularly after cryotherapy or laser treatment.
No treatment outcome can be guaranteed. Results vary depending on scar age, scar size, scar location, skin type, genetics, previous treatments, healing response, and aftercare compliance.
If a scar is changing rapidly, bleeding, ulcerating, unusually painful, or has an unclear diagnosis, further medical assessment or biopsy may be required before treatment.