How to Get Rid of Keloid Scars: Effective Solutions and Treatments
Keloid scars are raised, often itchy or painful, scars that grow beyond the boundaries of an original wound. Unlike hypertrophic scars, they do not remit naturally and frequently return even after treatment. Advances in molecular biology, clinical trials, and combination therapies in 2025 are opening new doors for more effective, lasting treatments. This article dives into the latest science and hands-on solutions so you can understand what treatments are working now, how to choose among them, and realistic expectations for recovery.
Understanding Keloid Formation and Why They Persist
Keloids form when fibroblasts (cells that produce collagen) overreact during healing, producing excessive collagen and extracellular matrix. This process is driven by inflammation, growth factors like TGF-β, genetic predisposition, skin tension, and certain skin types (especially darker skin tones). Collagen overproduction isn’t merely cosmetic—it distorts normal tissue architecture, causes itching, discomfort, and psychologically impacts quality of life.
One persistent issue is recurrence. Traditional treatments such as corticosteroid injections frequently reduce keloid size but have recurrence rates over 50%. Recent molecular studies have focused on targeting key pathways: prolyl-tRNA synthetase (PRS) inhibitors have shown ability in lab models to reduce fibroblast activity, collagen production, and inflammation. These findings suggest new targets beyond merely cutting or flattening the scar.
Many skin types differ in how prone they are to keloids. For example, individuals with Black, Asian, or Hispanic ancestry often experience more aggressive scar formation. Skin tension (areas where skin is stretched) and wound infection also increase risk. Knowing these risk factors helps in prevention and in selecting treatment strategies that reduce recurrence and side effects.
Evidence-Based First-Line Treatments
The foundational treatments that dermatologists rely on remain silicone gel sheeting or medical silicone gel plus occlusion, combined with corticosteroid injections. Silicone works by occluding (covering) and hydrating the scar, helping reduce water loss, suppress excess collagen and reduce redness. Corticosteroids such as triamcinolone help reduce inflammation and fibroblast proliferation. Meta-analyses currently confirm these are still the starting point for most keloids.
Another first-line adjuvant is intralesional 5-fluorouracil (5-FU), which inhibits fibroblastic proliferation when injected directly into the keloid. Combination of corticosteroid + 5-FU shows better results than either alone for many patients. Clinical protocols often use repeated injections over weeks to months. Side effects can include thinning skin or pigmentation changes, especially in darker skin types.
Non-invasive physical methods also play a role. Pressure therapy using garments or occlusive dressings can help flatten scars over long time periods. Similarly, sheeting, taping, and silicone patches are useful in early or flatter scars. These methods require compliance—daily use for many months—but they reduce recurrence when paired with injections.
Novel and Cutting-Edge Therapies in 2025
A number of emerging therapies have shown promise in recent clinical studies. Photobiomodulation therapy (PBMT) is non-invasive, using light wavelengths (often red or near-infrared) to reduce fibroblast activity, suppress TGF-β1 expression, and modulate inflammatory signals. Clinical trials have noted improvements in scar height, pliability, and subjective symptoms with PBMT, with minimal side effects.
Another promising approach is molecularly targeted therapy. For example, the PRS (prolyl-tRNA synthetase) inhibitor derived from recent South Korean research reduced collagen production and disrupted myofibroblast activation in lab and animal models. Translating that into human trials will be key. Also, therapies targeting the enzyme CYP24A1 in conjunction with vitamin D are under investigation to alter fibrotic signaling and reduce severity of keloid tissue.
Biologic drugs and immune modulators like Dupilumab (originally used for eczema/asthma) and ritlecitinib (a JAK3/TEC inhibitor) are now being tested in randomized clinical trials for keloid prevention or treatment post-excision. These drugs regulate immune pathways that contribute to chronic inflammation and excessive scarring. Early results are mixed, but some show potential in reducing growth and recurrence when used carefully.
Combination Protocols: What Works Best Together
Because monotherapy (single treatment) often fails over time, combination therapies are proving more effective. A recent comparative efficacy meta-analysis ranked several combinations by lower recurrence, including corticosteroid + bleomycin, excision + brachytherapy, cryotherapy + corticosteroid, and corticosteroid + 5-FU + brachytherapy. These combinations outperform single treatments in many studies.
The ASAP protocol, for instance, couples hydrocolloid occlusion, 5-FU/triamcinolone injections, and intense pulsed light (IPL) therapy. Published data show two-thirds to four-fifths of patients achieve significant flattening and symptom relief, with recurrence rates dropping well below traditional protocols. Patients undergoing ASAP saw fewer side effects and better outcomes in pigmented skin.
Surgical excision followed immediately by adjuvant treatments (radiotherapy, brachytherapy, or injection therapies) yields better long-term results than excision alone. For example, a case using superficial radiotherapy after trepanation resulted in no recurrence at three years follow-up on an upper lip keloid that failed steroid and laser treatments prior.
Step-by-Step Guide: Getting Rid of a Keloid Scar
- Start with a professional evaluation. Consult a board-certified dermatologist or plastic surgeon experienced in keloid treatment. They will assess scar type, skin tone, size, symptoms, prior treatments, and risk of recurrence. A precise diagnosis may include ultrasound or biopsy to determine collagen content and scar vascularity. This helps tailor therapy rather than trial-and-error.
Ask about family history of keloids, wound healing history, and areas of skin tension. These details guide choice of treatments like whether to use pressure garments or choose excision plus adjuvant. Early intervention before scar becomes very raised often improves outcomes significantly.
Ensure discussions include risks (pigmentation changes, thinning, recurrence) as well as costs and time commitment. Some treatments require many sessions over months or even years, and insurance coverage may vary depending on location and method.
- Begin with first-line non-invasive therapies. Use silicone gel sheeting or silicone gel daily, combined with occlusion. Apply medical-grade silicone patches over the scar, wear pressure garments if recommended. Over 6-12 months, these can reduce thickness, color, and itch.
Simultaneously, intralesional corticosteroid injections (for example triamcinolone) can be initiated. Injections every 3-6 weeks are common. Monitor for skin thinning or adverse pigment change. If progress is slow or side effects strong, combining with 5-FU under supervision helps.
Use adjuncts like antihypertensive topical agents (e.g. verapamil), or agents under study such as losartan gel. Ensure skin protection from UV light to avoid hyperpigmentation and further inflammation.
- Consider laser, light, or radiation therapies. IPL (intense pulsed light) treatments combined with injection protocols help treat pigmentation and vascular features. Fractional lasers (CO2, erbium) can resurface scar edges or thin down raised tissue. These are typically used after first-line treatment has improved baseline scar condition.
Superficial radiotherapy or brachytherapy after excision can reduce recurrence. Use of radiotherapy requires precise dosing and experienced specialists, given potential risks. In suitable cases (e.g., earlobe, chest), this approach has produced long remission periods.
Photobiomodulation therapy is also non-invasive, with minimal downtime, used singly or alongside other treatments for enhancement of scar elasticity and thickness reduction.
- Investigative and molecular treatments. Ask your provider whether you qualify for clinical trials of newer agents like PRS inhibitors, Dupilumab, or ritlecitinib. These offer promise in reducing recurrence and tackling underlying biological drivers rather than just managing symptoms.
Explore adjuncts such as topical treatments targeting Vitamin D pathways (for example reducing CYP24A1 activity), or inhibitors that suppress periostin and profibrotic gene expression. These are not yet standard of care but are moving toward higher levels of clinical evidence.
Ensure proper follow-up. New treatments often need monitoring for side effects, especially in darker skin tones (risk of post-inflammatory hyperpigmentation). Keeping a photo log helps track progress and detect early signs of recurrence.
- Maintain long-term care and prevention. After initial treatment, maintain silicone sheeting or gel nightly, protect from sun, avoid trauma to treated area. Use pressure therapy where possible. Scar massage may help with pliability.
Monitor scar changes regularly; early retreatment if you detect regrowth (small nodules or edges rising) often prevents large recurrence. Treating early is less risky, less invasive, and more effective.
Support skin health through diet (adequate protein, vitamin C, vitamin D), hydration, possibly supplements if advised, and avoid smoking or other factors impeding healing.
Potential Risks, Side Effects, and What to Expect
Even with the most advanced treatments, risks are real. Corticosteroid injections can thin the skin, cause pigment changes or fat-loss beneath skin. Radiotherapy and lasers may cause burns, dyspigmentation or costs to consider. Some molecular agents under trial might carry systemic risks. Always discuss risk/benefit with a specialist experienced in your skin type.
Recurrence remains the big challenge. Even with combination therapies, recurrence rates historically over 50% can drop to 15-20% in newer protocols. Success often depends on adherence, early intervention, and personalized therapy. What works for one scar may not for another.
Time and patience are essential. Many therapies require months of active treatment and long follow-up (1-3 years) to confirm results. Don’t expect overnight flattening. But many patients do report reduced thickness, softer texture, less itching, lighter color, and better comfort within weeks to months if protocols are well managed.
Comparing Treatment Options: Which Is Right for You?
Choosing a treatment depends on scar size, location, skin type, prior treatments, and risk tolerance. For example, small scars on ear lobes might respond well to excision + postoperative radiotherapy, while large chest or shoulder keloids respond better to non-invasive combination methods due to risk of surgical trauma exacerbating scar growth.
Skin tone greatly matters: darker tones are more susceptible to hyperpigmentation and discoloration. Therefore, treatments like IPL, laser, or aggressive radiation must use settings adjusted for skin color. Providers in specialist clinics now follow protocols minimizing adverse pigmentation.
Cost and accessibility are also major factors. Some molecular therapies or biologics under trial may not be widely available. Treatments involving lasers, radiotherapy, or more complex protocols tend to cost more and require specialist centers. Always confirm whether insurance covers components (injections, surgery, light therapies).
Recent Case Studies & Research Breakthroughs
A recent clinical trial compared different combination therapies and found that pairing corticosteroid (triamcinolone) with bleomycin achieved highest SUCRA ranking, followed by excision plus brachytherapy. These combinations showed lower recurrence rates than many previous standard treatments.
Berlin-based studies of trepanation plus superficial radiotherapy in patients with keloids on the facial area (upper lip) showed no recurrence at three-year follow-up after earlier failed treatments including lasers and TAC injections. This suggests that aggressive, well-planned combination protocols may succeed even when other treatments have failed.
Another study of losartan-loaded gel (5%) in ethosomal formulation demonstrated measurable reductions in scar size and improved patient satisfaction, with minimal side effects such as itch or discomfort. Such topical molecular agents are promising because they are less invasive and lower in cost relative to surgery or radiotherapy.
Data Table: Comparative Metrics of Key Treatments
| Treatment Method | Typical Reduction in Scar Height | Recurrence Rate | Common Side Effects |
|---|---|---|---|
| Silicone + Corticosteroids | 30-60% in many studies after several months | ~40-60% historically; newer protocols reduce to ~20-30% | Skin thinning, pigmentation changes, injection discomfort |
| Combination (TAC + Bleomycin / Excision + Radiotherapy) | Often >60-80% flattening | Recurrence rates drop to ~10-25% in specialist centers | Risk of radiation-induced changes, higher cost, longer recovery |
| Photobiomodulation Therapy (PBMT) | Moderate (20-40%) especially on pliability and height | Still under long-term follow-up; recurrence lower when combined | Mild redness, temporary irritation |
| Emerging Molecular Agents (PRS inhibitor, Ritlecitinib, Vitamin D/CYP24A1 inhibitors) | Early data shows up to 50%‐70% reduction in lab/animal models; human data promising | Unknown, under trials; hope for lower recurrence | Potential systemic effects, cost, regulatory approvals pending |
Bullet List: Practical Tips for Patients
- Start early: Treat scars early when still soft. Early treatment often yields better outcomes than treating established, rigid keloids.
- Stay consistent: Regular use of silicone sheeting or pressure garments for several months (often 6-12) is essential to reduce height and prevent recurrence.
- Combine treatments: Using multiple modalities (injections, light therapy, surgery + adjuvants) tends to reduce relapse and produce more durable flattening.
- Protect your skin: Keep treated areas out of the sun. UV exposure worsens pigmentation and may stimulate collagen formation.
- Monitor and retreat early: If scar edges begin to re-rise or become nodular again, retreat with less invasive methods before they worsen.
- Choose a good provider: Dermatologists or plastic surgeons with specific experience in keloid management are more likely to adjust treatments to skin tone, scar location, and patient risk.
- Understand risks: Know potential side effects like pigment changes, thinning, and rare risks from radiation or biologics; weigh benefits and drawbacks.
- Support general skin health: Good nutrition, hydration, avoiding smoking, and managing systemic inflammation (e.g. diabetes) can improve healing and response.
What to Expect Long Term and Setting Realistic Goals
When pursuing treatment, it’s realistic to expect gradual improvement rather than complete elimination. Over months, you might see reduced height, softer texture, lighter color, less itching, and improved comfort. Full flattening, especially of large or long-standing keloids, may be rare but significant improvement is possible.
Recurrence remains the most common setback. Even with the best combination protocols, some scars re-grow due to inherent biology. What matters is reducing recurrence, symptom relief, and improving appearance to a level that’s satisfactory to the patient. Some new treatments aim to get recurrence under 20%, especially for moderate scars.
Continued follow-up over at least 1-2 years is advisable. Photograph scars periodically, keep records, and adjust treatment if needed. Don’t drop protective measures like silicone, pressure, or UV protection even after visible improvement. Often scar “flare-ups” occur with skin injury, so minimizing trauma is part of long-term success.
Conclusion
Keloid scars are challenging but advancing science is giving stronger, more effective tools. Combining classic treatments (silicone, corticosteroids) with newer options (molecular inhibitors, PBMT, laser/radiotherapy) and personalized protocols (like ASAP) currently offer the best chance of significant improvement with lower recurrence. Working closely with a specialist, being patient, and following rigorous follow-up are key.