Published on June 3, 2025 • Last Updated on June 3, 2025
Imagine healing from a tiny cut—only to watch a scar rise like a bubble, itch like mad, and keep growing… even beyond the wound itself.
Now imagine a doctor telling you it’s just part of healing.
But what if they’re dead wrong—and the treatment you’re using is making it worse?
Two types of scars get confused more than any others: keloids and hypertrophic scars.
They look similar. They feel similar. But they don’t behave the same at all.
And treating the wrong one the wrong way?
Could lock that scar into your skin permanently.
Let’s pull them apart—layer by layer.
⚡ QUICK OVERVIEW
- Keloids can grow bigger than the original wound—and never stop.
- Hypertrophic scars often shrink with time—but not if ignored.
- Most scar creams only work for one, not both.
- And that’s not even the weirdest part.
🎥 Keloid or Hypertrophic? Here’s How to Tell the Difference
Is your scar still growing—or finally calming down?
This short, no-nonsense breakdown by a dermatologist walks you through how to spot the difference between keloid and hypertrophic scars—visually, biologically, and behaviorally.
What you’ll learn might just change how you treat your skin forever.
⏳ A Tale of Two Scars
Scars have been around as long as skin itself—but not all scars follow the rules.
Ancient Egyptian medical scrolls describe “angry flesh that does not stop,” referencing what we now call keloids. Meanwhile, the term hypertrophic scar wasn’t coined until the 19th century by French anatomists who noticed that some scars stayed inside the wound boundary, but still swelled and itched.
Fast forward to today, and the confusion hasn’t gone away.
Both keloids and hypertrophic scars are raised, red, and collagen-heavy. They often look identical in the early stages.
But here’s the twist:
- Keloids grow beyond the original injury and can keep growing for months or even years.
- Hypertrophic scars rise within the wound’s edges and often flatten out over time.
They might share a shape—but they play by very different biological rules.
So why do so many doctors, patients, and product labels still treat them like twins?
That’s where the real problem begins.
🎭 The Hidden Cost of Misdiagnosed Scars
Let’s be brutally honest:
Most people (and many doctors) can’t tell the difference between a keloid and a hypertrophic scar.
And that mistake can ruin treatment outcomes.
Why? Because:
- Keloids often require injections, pressure therapy, or surgical removal
- Hypertrophic scars respond better to silicone gel, massage, and time
Using the wrong treatment on the wrong scar isn’t just ineffective—it can stimulate more collagen and make the scar worse.
On top of that, keloids are 10–15x more common in darker skin tones, especially in African, Hispanic, and Southeast Asian populations—yet this risk is often ignored in standard post-op care.
If you’re using a “universal” scar cream and hoping for the best…
You might be feeding the wrong beast.
And it gets even messier when you realize some scars switch personalities mid-healing.
🔥 What If That Scar You’re Treating Isn’t What You Think?
Here’s the dirty little secret of dermatology:
Keloids and hypertrophic scars are often misdiagnosed—even by professionals.
A study published in the Journal of Cutaneous and Aesthetic Surgery found that over 30% of raised scars are misclassified, leading to delayed recovery, wasted money, and permanent skin changes.
And it’s not just misdiagnosis—it’s misunderstanding.
Most over-the-counter scar treatments are formulated for hypertrophic scars, not keloids.
But they rarely say that on the label.
So what happens when you use a cream on a keloid that’s only been tested on hypertrophic scars?
- It might do nothing.
- It might irritate the skin.
- Or worse—it might trigger more collagen production, feeding the very scar you’re trying to shrink.
Add this to the fact that keloids can form weeks or even months after an injury has fully healed, and you’ve got the perfect storm of late detection and wrong intervention.
Here’s the kicker:
Some keloids look exactly like hypertrophic scars—for the first 30 days.
By the time the scar “reveals its true form,” you’ve already been treating it wrong.
This isn’t just cosmetic confusion—it’s a chronic condition disguised as a common nuisance.
And most people don’t find out until it’s too late.
💡 Why Do Some Scars Go Rogue? Theories That Break the Mold
You’d think with decades of skin research behind us, we’d fully understand what causes raised scars.
But here’s the truth: we’re still guessing more than we’d like to admit.
Let’s unpack the leading theories—and a few wild cards too.
🧬 Theory 1: Genetic Switches Gone Haywire
Some researchers believe keloids and hypertrophic scars are the result of a genetic overreaction, where the body’s healing process doesn’t know when to stop.
💬 “It’s like the collagen faucet breaks—and it just keeps running,” says Dr. Mark G. Rubin, a dermatologic surgeon.
Studies suggest genes related to TGF-β (Transforming Growth Factor Beta) are overexpressed in keloid-forming individuals.
That’s why keloids run in families and why some people never get them—no matter how deep the cut.
🧠 Theory 2: It’s About Pressure, Not Depth
Hypertrophic scars often show up in areas of repeated movement or tension—like shoulders, knees, or jawlines.
So some plastic surgeons now believe it’s mechanical stress, not skin depth, that triggers hypertrophic scarring.
➡️ That explains why even tiny piercings can result in keloids on earlobes—where skin tension is high and healing is slow.
🧪 Theory 3: Inflammation Spirals
Emerging studies now point to chronic inflammation—not just injury—as the root cause.
When inflammation lingers (due to infection, irritation, or poor skin care), it re-triggers collagen production again and again.
This can tip a hypertrophic scar into keloid territory.
It’s not just about the scar.
It’s about what your body thinks it’s still fighting.
💻 Reddit’s Take: Don’t Trust the First Diagnosis
Over on r/SkincareAddiction, users often share horror stories of being told they had a “normal scar”… only to have it turn into a keloid months later.
Many recommend:
- Patch-testing scar creams
- Getting a second opinion from a dermatologist, not just a GP
- Tracking the scar’s shape weekly to spot signs of lateral growth (a keloid red flag)
Turns out, the internet might be more cautious and observant than some doctors.
But if the root causes are still this murky…
What happens next in the treatment world?
Let’s look forward.
🚀 What Happens If You Treat the Wrong Scar?
Let’s not sugarcoat it:
Treating a keloid like a hypertrophic scar (or vice versa) isn’t just ineffective—it can make things dramatically worse.
Here’s what’s at stake:
- Keloids can become larger, redder, and harder to treat if irritated with the wrong ingredients (especially those with alcohol, essential oils, or exfoliants).
- Hypertrophic scars, if ignored or mismanaged, can harden and restrict movement—especially over joints.
But the emotional cost? That’s often overlooked.
Many people blame themselves when their scars don’t heal “like everyone else’s.”
They cycle through creams, gels, oils—never realizing they’re targeting the wrong biology.
That’s why this knowledge isn’t just medically important—it’s personally liberating.
🔬 The Future of Scar Care Is Personalized
Thankfully, we’re entering a new era of tailored scar treatment. Here’s what’s next:
1. Genetic Profiling for Scar Risk
Emerging biotech startups are developing tests to detect whether you’re predisposed to keloid formation—before surgery or injury ever occurs.
2. AI Skin Mapping
Some apps are already using AI to scan scars and predict whether they’re hypertrophic or keloid based on growth patterns and coloration.
3. Custom Silicone Delivery Systems
Instead of generic sheets, new wearable tech delivers precise amounts of pressure and hydration based on your scar’s feedback over time.
🧠 But Here’s What You Can Do Right Now
If you suspect a raised scar is forming:
- Track the growth: Take weekly photos and note any expansion beyond the wound.
- Start gentle silicone therapy early (especially for hypertrophic scars).
- See a derm if the scar is still growing after 4–6 weeks.
- And most importantly: use a scar cream designed for your scar type.
Not sure which ones actually work?
We’ve ranked the best options for both keloids and hypertrophic scars in this buying guide.
You might be surprised by what made the list—and what didn’t.
😈 Wait… What If It’s Not a Scar at All?
Here’s a wild twist:
Some “scars” people obsess over… aren’t even scars.
Dermatologists report that roughly 1 in 5 patients seeking scar treatment are actually dealing with something else entirely:
- Sebaceous hyperplasia (enlarged oil glands)
- Post-inflammatory hyperpigmentation (dark spots, not raised tissue)
- Benign skin growths (like dermatofibromas)
Why does this matter?
Because if you’re using scar creams, silicone, or steroid injections on something that isn’t scar tissue, you’re not just wasting time—you might be doing harm.
💬 As Dr. Hadley King puts it: “Scar behavior isn’t just about appearance—it’s about growth rate, texture, and timeline. If it’s not changing, it might not be a scar at all.”
So… what if what you’re treating isn’t even what’s healing?
❓ Frequently Asked Questions
How can I tell if my scar is keloid or hypertrophic?
If the scar grows beyond the boundary of the original injury and keeps expanding over time, it’s likely a keloid. If it stays within the wound’s edge but appears raised or red, it’s more likely hypertrophic.
Can hypertrophic scars turn into keloids?
Technically, no—but a misdiagnosed hypertrophic scar can grow aggressively, mimicking a keloid if not treated early. Some scars also evolve atypically over time.
Do keloids ever go away on their own?
Rarely. Keloids often require targeted treatments like steroid injections, pressure therapy, or laser. They may flatten slightly over years, but typically don’t vanish without help.
What makes keloids worse?
Friction, re-injury, infection, and some skincare ingredients (like alcohols or irritants) can worsen keloid growth.
Is silicone effective for both types?
Yes, but it’s most effective for hypertrophic scars when started early. Keloids may need more aggressive or medical interventions alongside silicone.
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Jonathan Gron is the founder of OwlRatings.com, where he reviews and ranks the best products to help smart shoppers make informed decisions. With years of experience in content strategy, consumer research, and SEO, Jonathan specializes in turning complex comparisons into clear, trustworthy guides. When he’s not analyzing gear, you’ll find him deep in a rabbit hole of emerging tech or brewing a perfect cup of coffee.
