PI-WIKI-DERM-17 · Dermatology · reviewed 2026-10-31
Keloid vs Hypertrophic Scarring After Piercings & Tattoos
Critical numbers
Keloid Defining FeatureExtends beyond original wound margin
Hypertrophic Scar Defining FeatureConfined to original wound boundary
Keloid TGF-β1 ConcentrationElevated vs normal dermis
Collagen Type I : Type III Ratio (Keloid)Much higher than normal skin (~4:1)
Keloid Prevalence, African Ancestry4.5–16%
Keloid Prevalence, European Ancestry~1%
Recurrence After Excision Alone45–100%
Keloid Onset Window3–12 months post-injury
Hypertrophic Scar RegressionOften regresses by 12–18 months
Highest-Risk Anatomical SitesSternum, deltoid, upper back, earlobes
First-Line Scar ProphylaxisSilicone gel sheeting, 3 months minimum
First-Line Keloid Treatment (Medical)Intralesional triamcinolone (Kenalog)
Do not
- Assuming keloids are purely cosmetic
- Proceeding on a high-risk anatomical site without scar history screening
- Confusing hypertrophic scar with keloid
- Overworking high-risk skin
- Piercing with jewellery too heavy or too small a gauge
- Recommending topical vitamin E or onion extract as scar treatment
Applicable standards
- European Union & UK — UK: triamcinolone is a prescription-only medicine, so intralesional steroid…
- United States — State-level body art regulation
- ASEAN & Asia-Pacific — Thailand Ministry of Public Health