Keloid vs Hypertrophic Scar: How to Tell the Difference

Raised scars fall into two broad camps: hypertrophic scars and keloids. They can look similar at first glance but have very different biology, prognosis, and treatment response.

The short answer

Hypertrophic scars stay within the borders of the original wound and often flatten over 12-24 months on their own. Keloids grow beyond the wound margin into surrounding skin, don't regress without treatment, and recur easily.

How they look and feel

Hypertrophic scars are raised, red, and confined to the wound boundary. They commonly itch or feel tight while maturing. Keloids are firm, rubbery, often glossy, and can extend like a claw across normal skin. They're more likely to be painful or itchy for years.

Why the distinction matters

Hypertrophic scars often respond well to silicone sheets, pressure therapy, and time. Keloids rarely regress without active treatment and usually need combination approaches — steroid injections, cryotherapy, surgery plus adjunct, or laser-assisted drug delivery. Misidentifying one as the other can mean years of under-treatment.

Who is most at risk for keloids

Keloids are more common in people with darker skin tones, typically appear in the teen years through the 30s, and often run in families. Common sites include ears (especially after piercings), chest, shoulders, and upper back.

What to do next

If your scar keeps growing past the original injury, get it evaluated. Earlier treatment — especially silicone or pressure therapy in the first six months — is almost always easier than waiting for a mature keloid to form.