Why some people are more susceptible to Keloid Scarring

by Dr Wan Chee Kwang
September 28, 2023

The human body's response to injury and healing is unique to each individual . While scars are a natural part of the skin's healing, keloid scarring can be confusing and distressing for those who experience it.

A superficial wound may heal without a trace for some people, while for others, a seemingly minor injury can lead to raised and overgrown keloid scars. 

In this blog, we uncover the underlying factors that make certain individuals more vulnerable to keloid scarring. Understanding keloid formation can empower you to pursue effective removal strategies.

Genetic predisposition

If you've ever wondered why keloids seem to run in families or why some individuals are more prone to their development, the answer lies within our genes. If your parents or close relatives have experienced keloids, you might inherit a predisposition to developing them. 

Some genes associated with collagen production, wound healing, and inflammation play a pivotal role in determining whether your skin will produce excessive scar tissue in response to injury.

Genetic variations can lead to an imbalance in collagen production and regulation. Some individuals' bodies may overreact to even minor injuries, producing an excess of collagen that forms raised and thickened keloid scars.

Skin type

The characteristics of your skin, primarily determined by factors such as melanin levels and type, can influence how your skin responds to injuries and subsequently contributes to the development of keloid scars.

Melanin plays a pivotal role in keloid scarring. The high melanin production in people with darker skin tones can result in a heightened inflammatory response to injuries. This increased inflammation can lead to the overproduction of collagen, a hallmark of keloid scars.

Skin type also affects how efficiently wounds heal. People with certain skin types might experience prolonged inflammation after an injury, creating an environment conducive to keloid formation.

Inflammatory response

An individual's inflammatory reaction following an injury or trauma, including severe acne, can significantly influence whether a keloid forms and how it progresses. 

Some individuals possess an immune system that tends to react more intensely to injury, leading to excessive inflammation. This heightened response can result in the overproduction of collagen, causing the scar tissue to extend beyond the original wound boundaries and form a keloid.

Wound tension

The tension placed on a wound during healing can influence keloid formation. Wounds in areas with high tension, such as the chest or shoulders, are more prone to keloid development. Increased mechanical stress on the healing tissue may trigger an abnormal healing response and the formation of keloids.

Renin-angiotensin system

The renin-angiostein system controls blood pressure and has molecules like angiotensin II and receptors called AT1 and AT2. Some studies suggest that when angiotensin II acts on the AT1 receptor, it can make scars worse by causing more inflammation, blood vessel growth, and tissue building. Because of this the renin-angiostein system is linked to keloid formation. 

It should be noted, though, that more studies are needed to clarify the above mechanism. 

Nutrition (Vitamin D)

Keloid is caused by inflammation and overgrowth of fibrotic tissue during wound healing. Vitamin D can help to regulate this inflammation and studies have shown that vitamin D deficiency could predispose someone to getting keloids. 

Picking at skin

Continual rubbing, scratching, or friction on healing skin can exacerbate inflammation and scar formation. This constant irritation perpetuates the body's healing response, potentially leading to keloid development.

Picking at acne, scabs, or existing scars can also introduce additional trauma to the skin, provoking an inflammatory reaction that contributes to the growth of keloids.

Keloid scar removal in Singapore

At 1Aesthetics, we use lasers, injections and surgery for keloid removal and, where necessary, combine treatments for the best results. Here are some treatments that we may recommend for keloid scar removal.

Ultrapulse CO2 laser

CO2 laser targets water in skin cells, vaporising a layer along with nearby tissue. Ultrapulse CO2 uses short, powerful bursts of energy. It can be customised to remove abnormal tissue while minimising damage to the surrounding tissues. This laser aids in successful keloid removal and has been observed to improve keloid scarring.

Radiofrequency ablation

High-frequency radiofrequency targets water in cells, either vaporising or coagulating them based on the waveform. The insulated needles can treat deeper sections of the keloid, minimising downtime and scarring risk.

Vascular laser

Vascular laser for keloid removal targets blood vessels in the keloid. The heat from the laser damages vessel walls, and the body removes these damaged vessels. This treatment effectively reduces the size and redness of keloids.

Choosing a suitable laser depends on the keloid's features. Different lasers are used for different stages of keloid development. Longer wavelengths work for more extensive keloids, while shorter ones are for flatter, red keloids.

Intralesional steroid injections

Corticosteroid injection is a proven treatment for keloid scar removal. It reduces inflammation and collagen production, making keloids look and feel better. It's used alone or after laser treatment. Administering the proper dosage at the correct depth is crucial to avoid problems like skin thinning.


Keloid removal surgery removes the fleshy bulk of a keloid while reducing the chance of recurrence. Surgical procedures range from simple shave excision to more complex techniques such as intralesional fillet flaps. 

Cold steel, ultrapulse CO2 lasers, vascular lasers, and high-frequency radiofrequency may all be considered to dissect the keloid. Selecting the appropriate surgical procedure will give you your desired results depending on the characteristics of your keloid scar.


Neurotoxins can ease pain, itching, and make keloids thinner. Neurotoxin injections are also safe, causing less pain and skin problems.

Smoother skin with 1Aesthetics

From advanced laser therapies to corticosteroid injections, there are multiple ways to remove keloid scars. The crucial thing is to find a clinic you trust in Singapore and a doctor who can assess your skin condition and provide combination treatment when necessary. 

Book a consultation with 1Aesthetics. Dr Wan will provide personalised guidance and tailored treatments to help you feel better about your skin and yourself.


  1. Minglei B, Pengfei Sun. (2019). Intralesional Injection of Btx Type A Compared with Intralesional Injection of Corticosteroid for the Treatment of Hypertrophic Scar and Keloid. Medical Science Monitor. https://medscimonit.com/abstract/index/idArt/916305
  2. Thijs C H Oosterhoff, Vivian K Beekman. (2020). Laser treatment of specific scar characteristics in hypertrophic scars and keloid. PubMed. https://pubmed.ncbi.nlm.nih.gov/33645505/
  3. Hedayatyanfard K, Haddadi NS, Ziai SA, Karim H, Niazi F, Steckelings UM, Habibi B, Modarressi A, Dehpour AR. The renin-angiotensin system in cutaneous hypertrophic scar and keloid formation. Exp Dermatol. https://pubmed.ncbi.nlm.nih.gov/32678966/
  4. El Hadidi HH, Sobhi RM, Nada AM, AbdelGhaffar MMM, Shaker OG, El-Kalioby M. Does vitamin D deficiency predispose to keloids via dysregulation of koebnerisin (S100A15)? A case-control study. Wound Repair Regen.

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