You noticed a raised, firm lump where a wound once healed, perhaps after a piercing or surgery. You picked up a scar cream from the pharmacy, applied it faithfully every day, and waited. Weeks later, nothing has changed. If this sounds familiar, you are not alone, and more importantly, you are not doing anything wrong. The problem is not your consistency, but that scar creams were simply not designed for what you are dealing with.
Keloids are not ordinary scars. They are a sign that your body’s wound-healing process has gone into overdrive, producing far more collagen than is needed and refusing to stop. Understanding what makes them so different and why that difference has a direct bearing on treatment options is the first step towards actually making progress.
What exactly is a keloid?
When your skin is injured, your body sends collagen to the site to repair the damage. In most people, this process switches off once the wound has closed and the scar has formed. In people prone to keloids, that “off switch” does not activate properly. Scar-forming cells called fibroblasts stay overactive, producing excess collagen1 and causing the scar to keep growing beyond the original wound margin.
The result is a thick, raised, often shiny growth that extends past where the original injury was. Keloids typically appear as smooth, hard, raised tissue and can range in colour from pink to red, purple, or darker than the surrounding skin, often darkening further as they mature. Beyond their appearance, many people find them itchy, tender, or even painful.
Keloids can develop after almost any type of skin trauma, like a surgical incision, a body piercing, an acne breakout, a vaccination, or even an insect bite. Certain sites on the body, such as the chest, back, knees, shoulders, jawline, and ears, are particularly prone to keloid formation.
Who is more at risk?
Anyone can develop a keloid, but some people are significantly more predisposed than others. People with darker skin tones, including those of Asian, African, or Hispanic descent, are 15 times2 more likely to develop keloids. Given Singapore’s predominantly Asian population, this is particularly relevant here.
Age is also a factor. Keloids are most common between the ages of 10 and 30, with lower prevalence in children and the elderly. A family history of keloids further increases the likelihood, which points strongly to a genetic component.
So why doesn’t scar cream work?
This is the question most people have after weeks of disappointment. The honest answer is that most over-the-counter scar creams are formulated for typical scars, ones that are gradually remodelling and fading on their own. They help flatten, soften, and fade scars that are naturally improving anyway. Keloids, by contrast, do not improve on their own. They are actively growing.
All commercially available topical scar products, including those containing vitamin E and herbal ingredients, emphasise preventive use because they are unlikely to reverse well-established keloids.
To put it plainly, even if you use these products perfectly, they cannot penetrate deep enough into the dermis to disrupt the overactive collagen-producing cells driving keloid growth. A lack of evidence and poor experimental outcomes have led to a lack of widespread adoption of topical treatments for keloids and hypertrophic scars.
There is one topical exception worth noting: silicone-based products, such as silicone gel sheets or silicone gels, do have some clinical backing. Dermatologists recommend using silicone-based products for at least 12 hours3 per day, and they work best on small keloids or as a preventative measure on fresh scars. However, silicone is most effective as a preventative tool or for managing very early, minor keloids, not for treating large or established ones.
What dermatologists actually recommend
Because keloids grow from deep within the dermis and involve a complex, ongoing biological process, they require treatments that work at that level. Here is what dermatologists in Singapore typically turn to:
1. Corticosteroid injections
This is the most widely used first-line treatment. A small amount of triamcinolone acetonide (a potent corticosteroid) is injected directly into the scar tissue, suppressing fibroblast activity, reducing inflammation, and breaking down excess collagen to gradually flatten and soften the keloid. Most patients require multiple sessions spaced several weeks apart.
2. Laser therapy
Laser treatment can address both the texture and the colour of a keloid. A combination of pulsed dye laser treatments and steroid injections is sometimes recommended, as the pulsed dye laser reduces blood supply to the area, while the steroid injections reduce scar formation and inflammatory response. Concurrent fractional CO2 lasers can also help with surface texture and augment results achieved from steroid injections alone.
3. Cryotherapy
Freezing the keloid from the inside out can reduce its hardness and size. Cryosurgery works best on small keloids and is often used after keloid surgery or alongside corticosteroid injections, as the freezing process can make the scar tissue more receptive to subsequent steroid medication.
4. Surgical excision (with adjunctive treatment)
Surgery alone carries a high recurrence risk. The recurrence rate after surgery alone can be as high as 60%, and scars may actually be worse after surgery without follow-up treatment. This is why surgical excision is almost always paired with post-operative corticosteroid injections, laser therapy, or in more severe cases, radiation therapy.
5. Combination approaches
Keloids can be difficult to treat, so dermatologists often use two or more treatments together to give patients a better result. This is now considered best practice, rather than the exception.
What this means for you
If you have been using scar cream and not seeing results, it is not a reflection of your diligence, but simply a sign that your keloid needs a different level of care. The good news is that effective, clinically backed options do exist. The key is getting an assessment from a qualified dermatologist who can evaluate the size, location, and maturity of your keloid and recommend a personalised plan.
You should see a healthcare provider if your keloid affects your self-esteem or appearance, causes pain, affects how you move, is not getting better with self-treatment, or has come back after a previous treatment. Early treatment, ideally as early as two to three weeks after stitches are removed, leads to significantly better outcomes, contrary to the common misconception that scars should be left to mature for six to twelve months.
Conclusion
If scar cream has not been cutting it, it may be time to speak to a specialist. At Angeline Yong Dermatology, our team offers a range of clinically proven keloid treatments tailored to your skin type, scar profile, and goals. We understand that keloids are not just a cosmetic concern; they can affect your comfort and quality of life.
Book a consultation with us today and find out which treatment is right for you.
References
Mayo Clinic. (n.d.). Keloid scar: Symptoms & causes. https://www.mayoclinic.org/diseases-conditions/keloid-scar/symptoms-causes/syc-20520901
Chike-Obi, C. J., Cole, P. D., & Brissett, A. E. (2009). Keloids: pathogenesis, clinical features, and management. Seminars in plastic surgery, 23(3), 178–184. https://doi.org/10.1055/s-0029-1224797
Segal, D., Gatta, F., & Gopal, A. (2025, October 19). Keloid scars: Causes and treatments. WebMD. https://www.webmd.com/skin-problems-and-treatments/what-are-treatments-for-keloid-scars