What’s the Relationship Between Keloids, Scars, and Tattoos?

A keloid is a type of raised scar. It’s made up of collagen and connective tissue cells called fibroblasts. When you’re injured, these cells rush to the damaged area to repair your skin.

Keloids can form over any of these skin injuries:

• cuts
• burns
• insect bites
• piercings
• severe acne
• surgery

You can also get a keloid from a tattoo. To seal the ink into your skin, the artist pierces your skin again and again with a needle. This process creates many tiny injuries where keloids can form.

Keloids are hard and raised. They have a smooth and shiny surface, and they can hurt or itch. Keloids stand out, because they’re typically reddish-brown and end up longer and wider than the original area of injury.

A hypertrophic scar looks a lot like a keloid, but they’re not the same.

A hypertrophic scar forms when there’s a lot of tension on a wound that’s healing. The extra pressure makes the scar thicker than usual.

The difference is that keloid scars are bigger than the area of injury and they don’t fade with time. Hypertrophic scars are only in the wound area and do tend to fade with time.

You can get a tattoo but it may result in complications.

Keloids can form anywhere, but they’re most likely to grow on your:

• shoulders
• upper chest
• head
• neck

If possible, avoid getting a tattoo in these areas if you’re prone to keloids.

You should also talk to your artist about testing on a small area of skin.

Your artist may be able to use an ink that’s less likely to show on your skin — like white ink on pale skin tones — to tattoo a dot or a small line. If you don’t develop any scar tissue during the healing process, you may be able to get a tattoo here or elsewhere.

The practice of inking over a keloid is called scar tattooing. It takes a lot of skill and time to safely and artfully tattoo over a keloid.

If you’re going to tattoo over a keloid or any other scar, wait at least one year to make sure your scar has fully healed. Otherwise, you might reinjure your skin.

Choose a tattoo artist skilled at working with keloids. In the wrong hands, the tattoo might damage your skin even more and make the scar worse.

If you already have a tattoo, watch for thickening skin that looks rounded over the inked area. That’s a sign that a keloid is forming.

If you do see a keloid start to form, talk to your tattoo artist about getting a pressure garment. These tight clothes may help minimize scarring by compressing your skin.

Cover up the tattoo with clothing or a bandage whenever you go outside. UV light from the sun can make your scars worse.

As soon as the tattoo heals, cover the area with silicone sheets or gel. Silicone can help slow the activity of fibroblasts and collagen formation, which cause scarring.

Pressure garments and silicone products can help prevent additional scarring.

Pressure garments apply force to the area of skin. This prevents your skin from thickening further.

Silicone sheets reduce the production of collagen, the protein that comprises scar tissue. They also prevent bacteria from getting into the scar. Bacteria can trigger excess collagen production.

You can also see a dermatologist with experience treating keloids — specifically tattoo-related keloids, if possible. They may be able to recommend other reduction techniques.

There’s no solid evidence that over-the-counter creams like vitamin E and Mederma shrink scars, but there generally isn’t any harm in trying.

Ointments containing herbs such as betasitosterol, Centella asiatica, and Bulbine frutescens may promote wound healing.

Your dermatologist may recommend one or more of the following removal methods:

• Corticosteroid shots. Steroid injections once every three to four weeks for a series of treatments can help shrink and soften the scar. These injections work 50 to 80 percent of the time.
• Cryotherapy. This method uses intense cold from liquid nitrogen to freeze off the keloid tissue to reduce its size. It works best on small scars.
• Laser therapy. Treatment with a laser lightens and minimizes the look of keloids. It tends to work best when combined with corticosteroid injections or pressure garments.
• Surgery. This method cuts out the keloid. It’s often combined with corticosteroid injections or other treatments.
• Radiation. High energy X-rays can shrink keloids. This treatment is often used right after keloid surgery, while the wound is still healing.

Keloids aren’t easy to get rid of permanently. Your provider may need to use more than one of these methods to fully remove the scar — and even then it may come back.

Talk to your provider about prescription imiquimod cream (Aldara). This topical may help prevent keloids from returning after removal surgery.

Keloid removal can also be expensive. It’s generally considered to be cosmetic, so insurance may not cover the cost. Your insurer may consider paying for part or all of the removal process if the scar affects your movement or function.

Removing a keloid that has grown on a tattoo may have a negative effect on the ink. It ultimately depends on how close the keloid is to the tattoo and which removal technique is used.

Laser therapy, for example, may have a blurring effect on the ink. It may also fade or remove the color entirely.

Keloids can grow back after you’ve removed them. The odds of them growing back depend on what removal method you used.

Many keloids grow back within five years after corticosteroid injections. Almost 100 percent of keloids return after surgical excision.

Using more than one treatment method can increase the likelihood of permanent removal. For example, getting corticosteroid injections or cryotherapy and wearing pressure garments after surgery can help reduce your risk for return.

Keloids aren’t harmful. When associated with skin injury, once a keloid stops growing, it’ll usually stay the same.

However, keloids can affect the way your skin looks. And depending where they grow, they could interfere with your movement.

If a keloid bothers you or is stifling your movement, make an appointment with a dermatologist.