What Are Keloids?

Keloids are raised scar tissue that can grow up to 12 inches in size. They can occur when the skin heals after an injury and are often much larger than the original injury.

Both keloids and hypertrophic scars are a build-up of too much scar tissue, but a keloid will grow beyond and outside of the margins of the scar, whereas a hypertrophic scar is smaller and stays within the scar boundary.

It can take three months or more for keloids to show up after an injury. They’re slow-forming, continuing to grow for years after they start.

They start as a raised scar, being pink, red or purple, and are typically darker than the skin. They usually will stay firm and darken over time, with the center often being lighter than the border.

Keloids feel different than skin — they’re soft and dough-like or hard and rubbery. They can cause pain and itching and be tender to the touch, but the discomfort should stop once the keloid is done growing.

Do Tattoos Cause Keloids?

There’s no limit to where keloids can come from, so yes, tattoos can cause keloids, just the same as any trauma to the skin can. Although they can form anywhere, keloids are most likely to occur on the shoulders, upper chest, head and neck.  Keloids have a higher chance of forming when an area is under tension – joints and areas overlying large muscles that expand and contract frequently.  Avoid getting tattoos in these areas if you’re worried about keloids.

If you know you’re prone to keloids, you should probably avoid tattoos. If you’re really set on getting a tattoo with keloid-prone skin, ask your artist to do a test. They can tattoo a small line or dot that’s close in color to your skin tone. If no keloids form when it heals, you may be able to get a tattoo in that area.

If your test goes well and you decide to pursue ink, go with a small tattoo in the tested area. If all goes well, add to it over time. There’s nothing wrong with slow and steady if you’re worried about keloids. Choose your location carefully.

Can You Tattoo Near or Over Keloids?

Tattooing over scars isn’t unheard of. Usually it’s done over flatter scars, but it’s possible to tattoo over keloids. 

Tattooing over keloids takes a lot of time and skill. Make sure your tattoo artist has experience in this area. Done wrong, it can cause even more damage and worsen the scar.

Make sure your scar has fully healed before you tattoo over it. If your skin hasn’t healed, you might reawaken an old injury. Consult a medical practitioner before tattooing over or near keloids. 

Can You Prevent Keloids?

Pressure Bandages

There’s no way to completely avoid the formation of keloids. If you’re prone to keloids and are worried after a tattoo, look into pressure bandages. You’ll want to talk to both your tattoo artist and medical practitioner about this. Your practitioner will understand keloids, and the tattoo artist knows the tattoo’s needs best.

UV Rays

Your tattoo needs air to heal but covering it when outside is recommended. The sun emits harmful UV rays, which can make scars worse. If it’s too warm to cover your tattoos, make sure to wear plenty of sunscreen.

Silicone, Collagen and Bacteria

As keloids can form even months after the skin heals, you can take precautions once the tattoo is healed. Consider placing silicone sheets over the tattoo regularly for keloid prevention. Silicone reduces collagen production, and collagen is the protein that comprises scar tissue. Do take into account that collagen is an important protein for the body, though.

Bacteria can also trigger the creation of excess collagen. Covering the tattoo with silicone sheets can help protect the area from that bacteria.

Can Keloids Be Removed? Will It Ruin My Tattoo?

There are plenty of ways to remove keloids, but they are difficult to remove for good. Some of the removal methods do work better than others, though.

Keloid removal can be expensive — if you’re lucky, insurance may cover some of the costs. Talk to your insurer if this is a worry for you — you may be able to work something out.

Tattoos can be ruined by the keloid removal, if not ruined by the keloid itself already. For example, laser removal may fade the ink — lasers are generally used as a tattoo removal method anyway. Also, surgery may ruin a tattoo further by removing some, if not all, of the inked skin.

You should always put your health above your physique. If your keloid is causing you pain, you may have to choose the removal over the ink. You can always get your tattoo touched up if you have to and are willing to.

So, how do you remove keloids? Different treatments work for different people. Your doctor will know which option is best for you:

• Steroids
• Freezing
• Laser therapy
• Surgery
• Radiation

Steroid Injections

They’re not 100 percent effective, but corticosteroid shots can shrink and soften keloids. It’ll require a series of treatments every few weeks. If you have dark skin, be aware that corticosteroid injections may cause hypopigmentation (skin whitening) – go to a Board Certified Dermatologist for the best injection technique to minimize risks.

Freezing

Small keloids can be treated with cryotherapy. Liquid nitrogen is used to freeze off the tissue, reducing its size. Liquid nitrogen is sometimes used to soften the skin before doing a steroid injection.  This may also cause skin lightening and is not recommended in dark skin unless the benefits outweigh the risks.

Laser Therapy

Laser therapy works best with injections or pressure garments. It minimizes the look of keloids by lightening their color.

This treatment works well combined with the steroid injections; however, some doctors will advise against any other form of treatment, favoring only the laser and injections.

Surgery

Keloids can be removed surgically but are likely to return. You can take steps to prevent the return, like using pressure garments. Surgery is often combined with other treatments — it depends on what your medical practitioner or dermatologist thinks is best for you.

Since keloids are from an overzealous production of collagen scar tissue, any trauma to the area is likely to cause a recurrence because the cells of your body are programmed in this area to respond this way. 

Many times, people are happy with their keloid surgery removal, and then 3 months later, their keloid is bigger and worse than before surgery.  Tread cautiously and only go to a Board Certified Dermatologist who understands skin physiology.

Radiation

Radiation is often used as a treatment when the wound from surgical removal is still healing. It’s often used for recurrent keloids.

It’s most effective to start radiation treatment on the day of surgical removal.

Who’s At Risk of Keloids?

Anyone with a skin wound is at risk of keloids. These injuries include:

• Tattoos
• Cuts
• Surgical incision sites
• Puncture wounds
• Severe acne
• Insect/animal bites
• Injection sites
• Chickenpox
• Piercings

Keloids are rare, but some people are more at risk. People with darker skin are more likely to develop keloids.

More risk factors include:

• Pregnancy
• Teenagers going through puberty
• A family history of keloids
• Being under 30

The Bottom Line

If you end up with a keloid after a tattoo, it’s probably not a good idea to get another one. It may have been just a one-off unlucky break, but take precautions. Look after your skin, and keep an eye out for keloid growth after other injuries.

As long as you’re happy with how your tattoo looks — keloids, or lack of — it shouldn’t matter what others think. Don’t be afraid to address your keloid worries or take pride in your looks even after they form. Sometimes beauty really is pain, or in this case, beauty is keloids.