Keloids can be shrunk, but no single treatment eliminates them in one step. The most effective approaches combine two or more therapies, and even then, treatment typically spans several months. What works best depends on the keloid’s size, location, and how long you’ve had it.
Before diving into options, one distinction matters: keloids grow beyond the edges of the original wound into surrounding healthy skin, while hypertrophic scars stay within the wound’s original borders. Hypertrophic scars often flatten on their own over time. Keloids don’t. If your raised scar has spread past where the injury was, you’re likely dealing with a keloid, and it will need active treatment to shrink.
Steroid Injections: The Standard First Step
Corticosteroid injections directly into the keloid are the most common starting treatment. The steroid works by breaking down the excess collagen fibers that make the scar thick and raised, while also reducing inflammation and slowing the production of new scar tissue.
Injections are typically given every four to six weeks, with most people needing two to three sessions, though treatment can continue for six months or longer for stubborn keloids. This approach flattens 50 to 100 percent of keloids over time. The concentration of the steroid is adjusted based on the keloid’s location, with thicker skin areas like the chest or back usually requiring a stronger dose than the earlobes.
The injections can be painful, especially for dense keloids, though your provider may numb the area first. You might notice some temporary lightening of the skin around the injection site, particularly on darker skin tones. The keloid often feels softer and looks flatter within a few weeks of the first injection.
Combination Injections for Better Results
When steroid injections alone aren’t enough, adding a second medication to the injection mix significantly improves outcomes. In one comparison, only 20 percent of patients reported more than 50 percent improvement with steroid injections alone, while 55 percent of patients hit that same benchmark when a second anti-scarring agent was combined with the steroid. These combination injections are given at two-week intervals, typically over six sessions spanning about 10 weeks.
This combination approach is especially useful for keloids that have partially responded to steroids but plateaued, or for larger keloids that need more aggressive treatment from the start.
Silicone Sheets and Gels
Silicone is the most accessible over-the-counter option. Silicone sheets are thin, flexible patches you wear directly over the keloid. They work by trapping moisture against the scar, which signals your skin to slow collagen production and soften the tissue.
For silicone to actually work, consistency matters more than anything. You need to wear the sheet for at least four hours a day, for a minimum of three months. Continuing for six months or longer helps prevent the scar from re-thickening after you stop. Silicone gel (applied like a lotion) is an alternative for keloids in spots where a sheet won’t stay put, like the chest or behind the ear.
Silicone won’t dramatically flatten a large, mature keloid on its own, but it’s a reasonable first try for smaller or newer keloids, and it works well as an add-on alongside injections or after surgical removal to keep the scar from coming back.
Cryotherapy: Freezing the Keloid
Cryotherapy uses extreme cold to destroy keloid tissue. There are two approaches, and the difference between them matters significantly.
Surface freezing (spray or contact cryotherapy) applies liquid nitrogen to the outside of the keloid. It can help with smaller scars but often requires many sessions and carries a higher risk of blistering and permanent skin lightening, which is a particular concern on darker skin.
Intralesional cryotherapy is a newer technique where a needle is inserted into the keloid and liquid nitrogen freezes it from the inside out. This destroys more of the deep scar tissue while sparing the skin surface, which reduces blistering and pigment changes. It also requires fewer treatment sessions than surface freezing. The keloid’s blood supply is damaged during freezing, and the destroyed tissue is gradually replaced by normal scar tissue rather than keloidal tissue.
Laser Treatment
Pulsed dye lasers target the blood vessels feeding the keloid, which reduces redness and can soften the scar over time. Sessions are spaced four to eight weeks apart, with at least three treatments needed to see meaningful improvement. Some treatment plans extend to 12 sessions for larger or more resistant keloids.
Laser therapy is particularly effective at reducing the redness and flushing that makes keloids visually prominent. In one study, laser treatment reduced redness by over 52 percent after multiple sessions, compared to about 15 percent with other methods. Adding laser treatment on top of injection therapy also produced significantly better redness reduction than injections alone.
One caveat: results tend to be stronger for people with lighter skin tones. On darker skin, the improvement in redness is less consistent, and there’s a slightly higher risk of pigment changes from the laser itself.
Surgical Removal and Radiation
Surgery can remove a keloid entirely, but cutting alone is a gamble. Without any follow-up treatment, keloids grow back 45 to 100 percent of the time, and the regrowth is sometimes larger than the original. This is because the surgery itself creates a new wound, which triggers the same overactive scarring response that caused the keloid in the first place.
The picture changes dramatically when surgery is paired with radiation therapy delivered shortly after the procedure. In a review of keloids treated with post-operative radiation, 82.5 percent did not recur. The radiation is delivered in a small number of targeted sessions and is limited to the scar area, minimizing exposure to surrounding tissue. This combination is typically reserved for large keloids or those that haven’t responded to less invasive treatments.
Pressure Therapy
Pressure devices work by compressing the keloid, which reduces blood flow to the scar tissue and slows its growth. For ear keloids, specially designed pressure earrings (sometimes called Zimmer splints) are the most common form. They’re often used after surgical removal or injection therapy to prevent regrowth.
The commitment is significant: you need to wear them up to 16 hours a day for six to 12 months. Many people find them uncomfortable, and compliance is the biggest barrier to success. But for ear keloids specifically, they’re one of the most reliable ways to keep a treated keloid from returning.
Why Home Remedies Aren’t Reliable
Apple cider vinegar and tea tree oil are frequently recommended online for keloids. The theory behind apple cider vinegar is that its acetic acid has antibacterial properties, and tea tree oil has mild antimicrobial effects. In practice, there are no large, well-designed studies confirming that either one shrinks keloid tissue. The limited evidence that exists is preliminary at best.
More importantly, applying undiluted apple cider vinegar to a keloid can cause skin irritation or chemical burns, which could actually worsen scarring. If you want to try it, diluting one part vinegar with two parts water reduces the risk of irritation, but keep your expectations realistic. These remedies are not substitutes for proven treatments, and the months spent hoping they’ll work are months the keloid may continue growing.
Choosing the Right Approach
For small or newer keloids, starting with silicone sheets and steroid injections is reasonable and effective for many people. If the keloid doesn’t respond after a few injection cycles, adding a second medication to the injection or incorporating laser or cryotherapy is the typical next step. Large keloids that significantly affect your quality of life, or those in cosmetically sensitive areas, may benefit from surgical removal followed by radiation and pressure therapy to prevent regrowth.
Keloid treatment is almost always a process, not a single event. Most people go through multiple rounds of treatment over several months, and managing expectations around that timeline makes the process less frustrating. The keloids most likely to respond well are those treated early, before they’ve had years to mature and harden.