Common Lumps & Bumps – Keloids & Hypertrophic Scars

What are they?

Keloids/ hypertrophic scars are a very common lesion. Practially everyone in Singapore knows or has seen someone with an unsually large firm fleshy (or sometimes red) lesion over the left deltoid region (the so-called BCG scar).

keloid

Keloid

Keloids and hypertrophic scars are formed by the body’s exaggerated healing response to wounds and injuries. When you get a cut or a wound the body will heal itself by closing the defect with fibrous tissue. This can sometimes leave a small mark known as a scar. Occasionally, the healing process may be exaggerated and you get an abnormally large or prominent scar, otherwise known as a keloid or a hypertrophic scar.

Hypertrophic scars can be distinguished from keloids by the following:

hypertrophic scar

Hypertrophic scar

  1. Hypertrophic scars tend to stay to the margin of the original wound

  2. Hypertrophic scars generally tend to soften and flatten over time, unlike keloids, which progress to grow over the years.

Why do I get them?

As previously stated, these lesions tend to develop after injuries to the skin. Keloids and hypertrophic scars can arise from anything, from surgical scars, ear piercings, BCG vaccinations to even trivial causes such as acne. There is no hard and fast rule to predict who or even which skin lesion will develop into a hypertrophic scar or a keloid. The areas over the sternum ( upper chest), deltoid (shoulder) and the upper back tend to have an increased risk of keloid and hypertrophic scar formation.

Keloids and hypertrophic scars are also noted to be associated with infected wounds, foreign bodies in the wound, wounds with high tension closure and repeated trauma. Addtionally, keloids tends to form more frequently in Asians and darker skinned people.

Are they dangerous?

Neither keloids nor hypertrophic scars are dangerous. They may however cause localized irritation, itching and occasionally pain. If either forms in an area of the skin exposed to frequent motion, this may cause friction and discomfort. Keloid scars in particular are quite unsightly and many people are keen to get rid of them for this reason.

What should I do?

The best way to treat keloids and hypertrophic scars is to not let them occur in the first place. This means taking care of any wounds, keeping them clean and avoiding contamination. Appropriate and timely closure of large wounds such as cuts and lacerations may also reduce the risk of keloid and hypertrophic scar formation. There are a number of topical applications available that are targeted to minimize poor wound healing. However, even with your best efforts, it may not be possible to prevent them from happening.

How do I get rid of it?

Both hypertrophic and keloid scars can be treated in similar ways, although keloid scars tend to respond less favourably and have a higher chance of recurrence. In addition, hypertrophic scars tend to flatten and soften over time, unlike keloid scars which usually get bigger with time.

Classically, intralesional steroid injections have been used to treat keloids and hypertrophic scars, with a good degree of success.

intralesional injection

Intralesional steroid injection

While it may flatten the lesion, the discoloration or atrophic appearance of the scar will often remain. Steroid injections must also be applied cautiously for fear of thinning the skin. For this reason, the course of treatment is usually a series of injections applied to the lesion over the duration of a few weeks or even months, rather than a single large depot dose of steroid.

There are a lot of topical applications in the market that are available to help reduce keloids and hypertrophic scars. These applications often include retinoic acids, Vitamins A and E,  corticosteroids as well as antihistamines. Response to these creams has been varying.

Compression of the lesions also seems to help, particularly with keloid wounds. Its thought to interfere with the continued inflammatory process associated with the progressive growth of keloids. However, compression often needs to be applied for up to 23 hours daily for 6 months of more. This makes it impracticable for facial and other visible keloid lesions.

Cryotherapy has recently been used with good respone. The cyro-agent is used to induce cellular destruction in the keloid or hypertrophic scar over a series of sessions.While it shows good results in up to 60% of lesions, it is important to note that cryotherapy may cause hypopigmentation.

Surgical excision is usually a last resort when it comes to dealing with keloids in particular. There is always a chance that the keloid will recur or even worsen post surgery. Hypertrophic scar tend to respond a bit better. Recently, there have been combinations of traditional surgical excision with laser irradiation and external beam therapy to prevent the reactive regeneration of the lesion. However this has to be used very cautiously, as there is a potential for beam radiation to potentiate tumors.

Learn more about the Top 6 remedies for Keloids. Click here

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80 Comments

  1. Hello doctor. I did a mole removal on my arm but it did not recover well and left a keloid scar.
    I want to know how much is it to remove th keloid scar? It is abt 1cm or lesser a pretty small one

  2. Hi Doctor, I have keloids on my chin area. Have tried steriod injections for 2 – 3 years already on a monthly basis. Keloid did get smaller by a bit only. Was wondering is cryto a good method in reducing the keloid for chin area keloid?

    Thanks

  3. Melody

    Hi, I have a bump on my left ear lobe. I’m not sure whether it’s a keloid or cyst. It’s very soft and it’s skin colored.i don’t feel pain or itchy. I think I got that from piercing when I was younger. People are telling me that it’s a keloid, but it looks nothing like the photos I googled. More like a cyst. May I know what treatment options are available for keloid and cyst? And also please advise on the charges. Thanks!!!

    • drtan

      Hi. From your description it sounds like a cyst. Treatment for each is very different. Cysts can be excised out. Keloids require different treatments. We will reply you privately on estimated costs and fees.

      • mickey

        Dear Dr. Tan,
        I have keloid in my left arm, about 5cm.
        What treatment should i go for and what is the cost ?
        Appreciate your kind attention.
        Regards.
        Micky

        • The best treatment you should consider going for is steroid injection treatment. Cost is $120 before GST.
          http://www.drtanandpartners.com/where-to-find-us/

          • Sheila Yong

            Hi Doctor, can I understand the cost of $120 is per treatment or per large keloids? I have Kelios ranges from tiny to large along both my jaw lines. I’d like to understand your pricing better. Thank you.

          • Hi Sheila. $120 is the cost for 1 vial of steroid for injection. If we only need to use 1 vial for all your keloids, it is $120. If 2 vials are required, then it is $240.

          • Lizzie

            Hi
            Would u hv female doctors? As my keloids are at my private parts.. Please advise thanks

          • Yes, we do have female doctors. We can arrange a timing for a female doctor to attend to you if you wish.

  4. Hey,
    I ve a hypertrophic scar at my abdominal. My friend who has done this procedure, told me that it would make the scar wider. It’s like “melting” the thick scar down.
    Is this normal or depends on(amount, skill etc.)?
    Thanks in advance!

  5. Hi Doc,
    I have quite alot of hypertrophic scars on my chest. They are hard and bumpy. Is there a chance that they could be treated and disappear permanently? And do you charge for hypertrophic scars injection? Is it per scar? Thanks

    • Dr Elaine Loh

      Hi Rain, intralesional steroid injections may flatten and minimize the appearance of hypertrophic scarring, but it will not make it disappear completely. We charge $ 120 per session of injection. You will usually need more than 1 session, 3-4 weeks apart.

      • Hi,
        $120 per sessions means no matter how many scars you have on your chest?

        Thanks

        • Hi Rain. It is best that you come down to our clinics and see us to get a proper quote. It is very difficult to quote you an exact sum without first seeing you. This will also avoid any miscommunication.

  6. Hi Dr Tan,
    I have a keloid on both my arms due to tattoo removal. I have tried injections but it does not help. I want a permanent removal, do u do laser or surgery.

    • Unfortunately, laser cannot remove keloids permanently. We do not do surgical removal of keloids here. You may want to consult a surgeon for keloid surgery.

  7. I had a mole removed around 20 years ago. A small dot/mole remains with a bump that seems to be growing over the years. Not sure if it’s a keloid or hypertrophic scar or something else. Is this a something that I should be worried about? Thanks!

    • Dr Justin Sim

      This kind of issue would require a proper consult so we can see what is going on.

  8. Sumithavi

    Hi dr tan, I hav the keloid so many places in my body. Now it’s formed in my face 2 places. I’m lot of worry abt this. It’s not big now. But I want to stop grow and flattern. I used more injections, creams but it’s not cure. Once flat again it’s started to grow. Plz advise me and suggest. How much cost for per injection with consultation.

  9. Hi, can anyone help me to provide the address and opening hours of the clinic that provides cryotherapy for removal of keloids? Please help me. Thank you very much in advance.

    • Dr Elaine Loh

      Hi Zarina we do not have cryotherapy services but we do offer intralesional steroid injections for keloid treatment. You are most welcome to make an appointment with us so that we can assess and properly advise you on the treatment.

  10. Hi i’m 27 years old male. I have 3 big keloids on my shoulder abt 8 9 years ago. I started treat them abt 1 & a half year ago starting wif steroid injections but it didn’t respone quite well,have tried radiofrequency too but the result juz soso. After that i had laser surgery cut them off & inject steroid for each month. We add radiofrequency again when my wound was fully heal. The scar came bk but was not as raise as b4 but i wan it totally flat. After a year of steroid & lately added radiofrequency my scars dun seems like improve 🙁 i thinking abt change doctor & also get some positive review abt cryotherapy from a forum. What should i do? Plz reply me i need help 🙁

    • Our clinic offers steroid and steroid + Botox injection for keloid. We do not have cryotherapy service. If you are keen, please come in to any of our clinics for a consultation.

  11. Jackson

    Hi, I was reading some materials online with regards to steroid injection for keloid scars. Heard that the injections are really painful. Is it true?

    • Dr Justin Sim

      They can be painful. It all depends on personal pain tolerance.

  12. Hi Doctors,

    I want to do cryotherapy on my BCG scar. Which clinic offers this service?

    • Unfortunately, we do not offer cryotherapy now. We do steroid injection for hypertrophic scars and keloids. If you are keen, you can visit any of our clinics for an assessment.

  13. tracie

    Hi Doc,

    I have this dark spotted marks appearing on my legs. I am not sure if they are keloids. I have first noticed them about 4 years ago but it was just on two places but now, they seem to have been more and I wanted to know if you can share with me your charges on consultations.

    Thank you.

    • Dr Justin Sim

      Keloid appears as more than just marks – they usually protrude off the skin and can be quite large. They often occur dueto abnormal scarring. Small dark spots are impossible to diagnose accurately without us seeing you in person so you may wish to see a doctor to get this checked properly.

    • It is best to come in so we can assess visually and recommend the best treatment option.. Our consultation is $35-45. This is excluding any medicine or treatment.

  14. Hi Doc, I’m wondering whether you do treatment to eyes scarring from cosmetic surgery? It isn’t like steroid or hypertrophic but more of like discoloration of the skin (can tell that it’s a scar) at the inner corner and folds of the eyes. Can I get the cost please? Thank you

    • It is difficult to comment based on your description. It is best to come in to let us assess and advise accordingly. You are welcomed to visit our clinics.

  15. jamie

    Hi Dr Tan,
    For keloid steroid injection, does it helps to remove the redness beside the bump?

    • drtan

      Oh yes. In fact, steroid injections are really effective at getting rid of the redness.

  16. Catherine

    Hi I have been having severe keloid problems as a child and after chicken pox they were all over my body and face. I am now an adult and they have grown really massive. I have had injections done as a kid but they weren’t really effective. Is there someway I can have them removed? Especially those on my face? Thanks.

    • Surgical removal of keloid is not recommended, especially if it is on your face. You can either have a repeated injection done, or have a cryotherapy done. I would suggest an injection especially for the ones on your face.
      You are welcomed to visit us at our clinics to get them assessed so we can recommend the best treatment for you.

  17. Hi Dr Tan, I have 2 keloids; one on my ear, another one on my chest.
    The keloid on my ear has been there for 4 years. I’ve had surgery twice at TTSH (year 2010 & 2013) and several steroid injections after the surgery. It was fine until recently the bump increased to almost 1cm.
    The one on my chest has been there for almost 4 years as well. but i have not had any treatments for that, it’s approx 2cm big. i’ve seen positive treatments on cryotherapy or laser treatments… may i know the price of the treatments? i would also like to visit your clinic for appointment. isit better if i call or walk-in? thanks!

    • Cryotherapy for keloid is from $200
      Laser treatment will not shrink the keloid. It lightens the colour instead. It’s from $120 per session.
      Cryotherapy services will be available at Scotts clinic. We will email you the details.

      • I would like to have a cryotherapy done for the keloid on both my arms, how do I contact the clinic for further equiries?

        • We do not have cryotherapy service in our clinics. We provide steroid injection/steroid+Botox injection treatment for keloids and hypertrophic scars.

  18. Hi, my 2 year old son has a 1cm hypertrophic scar across the top of his nose (near the eyes) which was derived when he hit the edge of a table. He has had them for about a year. I am wondering if it is time to bring him in to see you for some sort of treatment like cyrotherapy/injection or should I just continue desensitising the area by massaging some paw paw ointment and let nature work some miracle? Thanks

    • The injections and cryotherapy can be quite uncomfortable. I do not think a 2 year old will tolerate it very well. Also since the scar is near his eyes, the last thing we want is for him to struggle and the needle to go somewhere is should not go. What I think you can do is to use a good cream or gel to reduce the scar tissue. You can see us for such medicine. A 2 year old’s skin is very plastic and usually heal very well from scarring without injections and cryotherapy.

  19. Hi I would like to know the charges for the different methods of removing keloid.
    My keloid is located at the mid helix area slightly higher than the lope, its not protruding out just a small bump.

    • Steroid injection is from $150 depending on the size. Cryotherapy is from $200 depending on the size too. Laser treatment to reduce keloid pigmentation is from $100 (does not shrink keloid).
      Right now we have steroid injection treatment available at Robertson and Bencoolen. Cryotherapy and Laser treatment will be available from mid April onwards.
      These prices are excluding GST and consultation.

  20. Hi Dr,

    I have develop several small keloids on my chest, largest one is probably only 1cm long.
    The rest varies from small pimple size to 0.4mm.
    If i was to count, there are approximately 12 scars on my chest and 2 on my right arms.
    They have all develop 5 years ago when I had acnes breakout, from my face and chest.
    I have tried tropical steroid cream from polyclinics but it won’t didn’t work.

    What is your advice? How much would it cost on estimate for steroid injection treatment for this?

    Thank you.

    • Sorry I cannot given medical advice over the internet. Generally speaking the treatments for keloids include intra-lesional injections with steroids with or without Botox. Silicon gel sheets or applications also work well in conjunction with injections. I would refrain from giving a quote on the internet. This is rarely accurate and can lead to misunderstandings. You are welcome to see any of our doctors for more advice.

  21. Hi im interested to to head down to the clinic for the steroid injections with botox or cryotherapy. Which clinic should i head to and which doctors should i look for ?

  22. Hi i had earlobe keloids before and it was removed already last three years. It grew back again this year and it grow bigger. Do u have cyrotheraphy treatment for earlobe keloid or do i have to go for surgery again?

    • It is very difficult to give an opinion over the internet. Please see us at our clinics and we will be happy to give you an opinion about treatment options.

  23. Hi dr,I have keloids in both upper arms near to my shoulder. I got them when I was in primary. Each of them measures approximately 5 inches long…Could you pls advise which treatment will be best suited for me? Thanks…

    • Wow. 5 inches is really big. I cannot give medical advice over the internet. You are most welcome to consult any of our doctors for medical advice.

  24. Hi,
    I have 2 acne keilod scar on my tummy and 1 chicken pox keilod on my back. They have been with me for 3-5 years before I went for laser treatment 2 years back. But it only flatten them and the discolouration is still there…but now all 3 came back again. Should I use the injection or surgical method to remove it? Will the discolour disappear together with the bump?

    • It is very difficult to give an opinion on this over the internet. You are welcome to visit us and our doctors will be more than happy to answer your questions.

  25. Hi! I have keloids on my chest and back shoulder area, can I ask what treatment is possible to reduce or rather, remove them? Thanks!

    • Hi Keeley,

      There are a few things that can be done to reduce keloid scars. Most commonly used are topical creams and intralesional steroid injections. Rarely are the scars removed surgically as this may worsen the situation.

  26. May I know how much do you charge for the steroid jab for a keloid scar?
    I have a very old keloid scar from my BCG jab, which was treated before with steroid jabs in my late teens. Now I’m 36 and it appears that one corner of it is starting to reactivate again even though I’ve been consistently applying scar gels. Looking fwd to your reply, thanks.

    • I hope you are using Silicon based gels. They work the best. We charge between $60 and $120 for steroid injections. There is also evidence that injecting Botox into keloids also help. Cost will depend on how much Botox is needed. We charge $16 per unit. Most small scars need 2 to 4 units i.e. $32 to $64 in addition to the cost of the steroid jab.

  27. Do you have this treatment called cryoshape ? reviews seem to be really really promising

    • Apologies. We do not. Cryoshape is a technology for slimming. I am sure you will be able to find a good practitioner who can conduct that treatment for you.

  28. Hi Dr, I have tried a variety of method to remove keloid on my jawline. Including steroid injections, combined with botox but it still doesn’t flatten. Is crypto therapy a viable option ?

    Its not massive, will it cause the keloid to regrow ?

    • You are taking a bit of a risk with Cryo. It can actually make the keloid bigger. You can try excising it instead. But this also has the risk of making a larger keloid. Although what most surgeons will do is inject steroid into the healing wound to reduce this risk.

      • I heard excising is absolutely the last resort but have heard good things about Cryotherapy, it also has the risk of reoccurrence ? My keloids are not very big but I have tried pulsed lasers, injections as well as botox and also silicone sheets but it still doesn’t improve ! Any suggestions ?

  29. Hi doc, i have a big keloid on the helix of my ear, like a one dollar coin but more protruding. Did surgery about 10 yrs ago and subsequently steroid injections on off, yet still recur. What other better options do I have cuz recently it grew at a faster rate and gets red and painful at times. Thanks in advance 🙂

    • You mean you had surgery to remove the keloid? And steroid injections and it still recurred? Wow. Tough one. You can try surgery again. Or you can try injecting it with a mixture of steroid and Botox. That has shown evidence to be more effective than steroids alone.

      • Hi Dr Tan,

        Thanks for replying.. May i ask for a rough cost for surgery and following injection of steroid+botox?

        Thank you in advance 🙂

        • We do not do the surgery. For that you should see a plastic surgeon. For steroid+botox injection, it depends on how large the keloid is. Each injection should be in the $200 to $300 range.

  30. Phoebe

    Hi I have some keloids on my arms and I would like to do cryotherapy as I have tried all other methods like steroid injections and laser. They are not as raised as they were as they are ten years old scars. However I would like to flatten damn completely. May I know what is the approximate cost of cryotherapy ?

    • Hi Phoebe,

      We’ll be glad to help. Our cryotherapy charges start at $30, but the actual cost would depend on the size of the lesion. We’ll need a review for an accurate estimate.

      • I have keloids on both my arms due to tattoo removal.i have tried steroids injections but it does not help. I badly want to go for a cryotherapy as the keloid are there for 10 years!! Please help and advise me on charges.

        • We do not have cryotherapy service in our clinics. We provide steroid injection/steroid+Botox injection treatment for keloids and hypertrophic scars.

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