Whether a scar stays inside its original wound edges or grows beyond them changes what treatment is likely to help. Keloid and hypertrophic scars look similar at first — both raised, both redder or darker than the surrounding skin — but they behave differently over time, and the management plan is not the same. Here is how to tell them apart and what the difference means, whether you are caring for your own scar or stocking a clinic shelf.
Keloid vs Hypertrophic: The Core Difference
A hypertrophic scar is an overactive healing response that stays inside the boundaries of the original injury. A keloid keeps growing beyond those boundaries into healthy skin, sometimes for months or years after the wound has closed. That single difference drives everything else.
| Feature | Hypertrophic | Keloid |
|---|---|---|
| Stays within the wound edges | Yes | No — spreads beyond them |
| Typical onset | Soon after wound closure | Weeks to months later, then keeps growing |
| Common sites | Any wound, often over joints | Chest, shoulders, earlobes, jaw |
| With time alone | Often flattens and softens gradually | Rarely resolves on its own |
| After surgical removal | Lower recurrence | Frequent recurrence without combined therapy |
Why the Distinction Changes Treatment
A raised scar that stays put usually responds to conservative measures. A keloid behaves more like a slow-growing tissue mass and often needs a clinician-led, combined plan. The goals differ too: for hypertrophic scars the aim is flattening and fading; for keloids the aim is halting growth first, then flattening.
Silicone therapy: the established first step for both
Silicone sheets are the recognized conservative starting point for both scar types. The sheet creates a hydrated, protected layer over the scar, and consistent daily wear is what does the work — typically 12 hours or more per day. Medical-grade silicone scar sheets are washable and reusable for weeks, which keeps the daily cost low. Where sheet edges lift during the day, a strip of hypoallergenic paper tape holds them flat without irritating the skin around the scar.
Hypertrophic scars: pressure and time do more of the work
Because growth stays within the wound, hypertrophic scars tend to respond well to silicone combined with focused pressure — pressure garments, elastic bandaging, or silicone sheets worn under compression where the anatomy allows. Improvement is gradual: expect softening and fading over months rather than dramatic change in weeks, and start treatment early for the clearest result.
Keloids: usually a multidisciplinary plan
Keloids respond less predictably to conservative care alone. Dermatologists and plastic surgeons commonly combine intralesional steroid injections, laser or cryotherapy, and sometimes excision — and because a keloid can regrow after simple excision, treatment is usually planned as a series rather than a one-time procedure. Silicone sheets still have a role as an adjunct between and after these treatments, but managing a true keloid without a clinician’s assessment is not advised.
What This Means for Clinics and Retail Shelves
For clinics, the practical takeaway is to offer silicone therapy early and teach patients the boundary test. In Canada, silicone scar products marketed for medical use are regulated as medical devices in Canada, so source them from a licensed supplier and keep the device labelling available. For anyone unsure whether a scar is keloid or hypertrophic, a physician or dermatologist should make the call before treatment starts — especially for scars on the chest, shoulders, or earlobes, where keloid behaviour is more common. Stocking reusable silicone sheets in a few sizes, plus hypoallergenic tape to hold them in place, covers most patients who ask about scar care.
FAQ
Q: How can I tell if a scar is keloid or hypertrophic?
A: Use the boundary test. A keloid grows beyond the edges of the original wound into healthy skin, often spreading like a blob or a claw; a hypertrophic scar stays within the wound outline. Keloids also tend to appear later and keep growing, while hypertrophic scars usually rise soon after healing and eventually plateau. Only a clinician can confirm which type you have.
Q: Do hypertrophic scars go away on their own?
A: They rarely disappear completely, but many flatten, soften, and fade over months to years without any treatment. Silicone therapy and pressure can speed that process and improve the final appearance. Keloids are different: they seldom resolve on their own and usually need clinician-directed treatment.
Q: Does silicone work on keloid scars?
A: Silicone can soften and flatten keloid tissue and is commonly used as an adjunct before, between, or after clinician procedures — but it is usually not enough on its own. A keloid that is still growing should be assessed by a dermatologist or plastic surgeon, who can combine silicone with injections, laser, or other therapy.
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