Why Do Keloids Form? Genetic & Lifestyle Factors in SG Explained

Introduction

Keloids — thick, raised scars that continue to grow beyond a wound’s original borders — can be both physically uncomfortable and emotionally frustrating. In Singapore’s warm, humid climate, where acne, piercings, and minor cuts are common, keloids affect people from all walks of life.

While many believe keloids form randomly, science tells a different story. They are strongly linked to genetics, skin biology, and lifestyle triggers such as skin trauma, tension, and even stress. Understanding these root causes is the key to prevention and effective treatment.

In this article, we’ll explain why keloids form, how your genes and habits influence their development, and what you can do to prevent and manage them. We’ll also highlight the latest medical solutions available at Dr Plus Clinic Singapore, where modern laser and injection therapies help patients regain smooth, comfortable, and confident skin.

What Exactly Are Keloids?

Definition

A keloid is an abnormal type of scar that forms when the body produces excessive collagen during wound healing. Unlike normal scars, keloids grow beyond the original wound area and do not regress on their own.

Appearance

• Raised, thickened, and rubbery texture
• Shiny or smooth surface
• Pink, red, or darker than surrounding skin
• Can feel tight, itchy, or painful

Common Locations

• Chest and shoulders
• Upper back
• Jawline and neck
• Earlobes (after piercings)
• Upper arms

Keloids can appear weeks or even months after an injury — long after the initial wound seems healed.

The Science of Wound Healing

To understand why keloids form, it helps to first know how normal wound healing works.

The Four Stages of Healing

1. Hemostasis: Blood clot forms to stop bleeding.
2. Inflammation: White blood cells remove bacteria and debris.
3. Proliferation: New collagen and blood vessels rebuild the area.
4. Remodelling: The scar matures and flattens.

In people prone to keloids, stage 3 and 4 go into “overdrive.” The fibroblast cells keep producing collagen even after the wound has closed, leading to excess tissue buildup.

Genetic Factors Behind Keloid Formation

1. Family History

Genetics plays a dominant role. Studies show that if one or both parents have keloids, the child’s risk increases by up to 50 percent.

2. Skin Pigmentation

Keloids occur more frequently in Asian, Malay, Indian, and darker-skinned individuals due to differences in collagen synthesis and fibroblast activity. Singapore’s multicultural population therefore experiences keloids more commonly than people in Western countries.

3. Genetic Mutations in Collagen Regulation

Research has identified mutations in genes controlling:

• TGF-β (Transforming Growth Factor Beta): Stimulates collagen production.
• SMAD and P53 Genes: Regulate fibroblast growth and apoptosis (cell death).
  When these signals malfunction, fibroblasts keep producing collagen without the “stop” command, forming keloids.

4. Inherited Immune Response

Certain individuals inherit a heightened inflammatory response to injury. Their bodies release more cytokines and growth factors, which in turn over-stimulate collagen deposition.

5. Hormonal Influence

Some evidence suggests oestrogen and growth hormone levels may affect scar formation, explaining why keloids can worsen during puberty or pregnancy.

Lifestyle & Environmental Factors in Singapore

Genetics may set the stage, but lifestyle determines how likely a keloid actually develops. Several day-to-day factors in Singapore’s environment contribute to their formation.

1. Heat and Humidity

Singapore’s tropical climate encourages sweating and friction, especially around the neck, chest, and underarms. Constant rubbing between clothing and skin triggers micro-irritations that can worsen existing scars or initiate new ones.

Tip: Wear breathable fabrics like cotton and avoid tight collars or straps that chafe keloid-prone areas.

2. Acne and Skin Picking

Acne breakouts — particularly on the chest, back, or jawline — are a leading cause of keloids. When pimples are squeezed or picked, they create deeper wounds that heal abnormally.

Prevention: Treat acne early with dermatologist-approved products or medications to reduce inflammation before scarring occurs.

3. Cosmetic Piercings and Tattoos

Ear piercings are one of the most common triggers for keloids in Singaporean teens and young adults. Likewise, tattoos create multiple micro-wounds that can lead to abnormal scarring if not cared for properly.

Advice: If you have a family history of keloids, avoid unnecessary piercings or body art — especially on the chest, shoulders, or earlobes.

4. Surgery or Medical Procedures

Even surgical incisions, vaccination marks, or mole removals can develop into keloids if the patient is genetically predisposed. Areas under skin tension, such as the chest or upper arm, are particularly high-risk.

Solution: Discuss preventive strategies (like silicone sheets or steroid application) with your doctor after any procedure.

5. Friction and Pressure

Repeated friction from bra straps, shoulder bags, or tight clothing can inflame small wounds, encouraging keloid formation.

Tip: Opt for looser fits and rotate accessories to reduce pressure on one area.

6. Poor Wound Care

Improper hygiene, infection, or delayed wound cleaning prolong inflammation — the key driver of excessive collagen production.

Best Practice:

• Clean wounds gently with antiseptic.
• Keep them moist with medical ointments.
• Avoid harsh alcohol-based products.

7. Emotional Stress

Chronic stress increases cortisol and inflammatory hormones, which can worsen scar tissue formation. While often overlooked, psychological health plays a genuine biological role in wound healing.

Recommendation: Engage in relaxation activities such as yoga, deep breathing, or regular exercise to maintain hormonal balance.

Who Is at Higher Risk in Singapore?

• Individuals with darker or medium skin tones
• People aged 10 to 35 years (peak hormonal period)
• Those with a family history of keloids
• Patients who underwent cosmetic surgery, piercings, or vaccinations
• Individuals prone to acne, folliculitis, or skin trauma

Early Warning Signs of a Developing Keloid

Identifying a keloid early can prevent it from growing larger.

Look Out For:

• Persistent redness or swelling at a wound site beyond 2 weeks
• Hardening or thickening of scar edges
• Itching or mild pain
• The scar expanding beyond its initial boundary

At Dr Plus Clinic Singapore, doctors use dermatoscopic assessment to detect early collagen overgrowth and intervene before full keloid formation.

Why Some Keloids Keep Coming Back

Even after removal or flattening, keloids can recur if:

1. Underlying collagen overproduction persists.
2. The treated area experiences tension or re-injury.
3. Post-treatment aftercare (like silicone gel use or sun protection) is neglected.

That’s why modern management focuses on long-term control and prevention, not just removal.

How Genetics and Lifestyle Interact

Think of keloid formation as a “two-hit” process:

1. The Genetic Predisposition (the spark) – inherited fibroblast hyperactivity.
2. The Environmental Trigger (the fuel) – skin trauma, infection, or hormonal stress.

When both factors coincide, collagen overproduction spirals out of control, resulting in a keloid.

This explains why two people with the same piercing may heal differently — one forms a normal scar, the other a keloid.

Can Keloids Be Prevented?

While not every case is avoidable, you can significantly reduce risk by adopting smart skincare habits.

Preventive Tips

• Treat acne promptly and avoid popping pimples.
• Protect healing wounds from sun exposure.
• Use silicone sheets or gels once the wound closes.
• Keep piercings clean and avoid unnecessary ones.
• Inform your doctor if you have a history of keloids before any surgery.
• Manage stress and maintain a balanced diet rich in Vitamin C and zinc.

Modern Medical Treatments for Keloids

Keloids may be stubborn, but they are treatable. Singapore’s latest medical approaches target the condition on multiple fronts: reducing collagen production, improving appearance, and preventing recurrence.

Below are the top evidence-based options offered at Dr Plus Clinic Singapore.

1. Corticosteroid Injections

These injections (commonly triamcinolone acetonide) reduce inflammation and fibroblast activity, softening and flattening the keloid over time.

• Frequency: every 3–4 weeks
• Sessions: 3–6 typical
• Result: less itching, flatter texture, reduced redness

2. Laser Therapy

a. Pulsed Dye Laser (PDL)

Targets blood vessels feeding the keloid, reducing redness and inflammation.

b. Fractional CO₂ Laser

Creates micro-channels that break dense scar tissue and enhance absorption of topical steroids or serums.

Advantages:

• Non-invasive, minimal downtime
• Improves texture and colour simultaneously
• Safe for Asian skin types

3. Combination Therapy (Laser + Steroid)

This approach delivers faster and longer-lasting results by attacking the keloid from inside and out.

1. Laser softens and remodels scar tissue.
2. Steroid reduces collagen overproduction.

At Dr Plus Clinic Singapore, this dual-method protocol is tailored for each patient’s skin tone and scar severity.

4. Cryotherapy

Freezing with liquid nitrogen destroys abnormal fibroblasts in small, firm keloids (especially on earlobes). It’s often paired with injections for greater effect.

5. Maintenance & Prevention

After flattening, maintenance may include:

• Silicone sheets to prevent re-thickening.
• Topical retinoids to regulate collagen.
• Sunblock to avoid pigmentation.

Results You Can Expect

• First Month: Reduced itchiness and redness.
• Three Months: Noticeable flattening and softer texture.
• Six Months: Colour fades and the scar blends with surrounding skin.

Most patients experience 70 – 90 % improvement after a complete course of therapy at Dr Plus Clinic Singapore, provided they follow aftercare instructions.

Cost Overview in Singapore (2025 Guide)

Why Choose Dr Plus Clinic Singapore

1. Expert Medical Team

All procedures are performed by licensed doctors trained in advanced scar management and laser technology.

2. Latest Technology

The clinic uses cutting-edge fractional CO₂ and vascular PDL lasers for safe, precise treatments tailored to Asian skin.

3. Personalised Treatment Plans

Each keloid is different — Dr Plus Clinic Singapore designs customised protocols that combine steroid, laser, and preventive care for optimal outcomes.

4. Safe, Comfortable Environment

Strict hygiene, proper anaesthetic use, and gentle techniques ensure minimal discomfort.

5. Transparent Pricing

Clear quotations with no hidden charges or unnecessary add-ons.

6. Proven Track Record

Hundreds of satisfied patients have regained smoother skin and confidence through professional care at Dr Plus Clinic Singapore.

Frequently Asked Questions

1. Are keloids dangerous?

They are benign but can cause itching, pain, or restricted movement if large.

2. Can keloids disappear on their own?

No. Without treatment, they often remain the same or slowly enlarge.

3. Are keloids contagious?

No. They’re an internal over-healing response, not an infection.

4. Do creams work?

Most over-the-counter creams have limited effect once a keloid is fully formed. Medical interventions yield better results.

5. Can lifestyle changes alone prevent them?

Healthy habits reduce triggers, but genetic predisposition means professional treatment may still be necessary.

Living with Keloid-Prone Skin

If you know you’re prone to keloids, proactive care makes all the difference.

• Moisturise daily to maintain skin resilience.
• Treat wounds immediately and gently.
• Inform doctors before surgical or cosmetic procedures.
• Manage stress and get enough rest for optimal healing.

Dr Plus Clinic Singapore also provides educational support for patients, helping them adopt daily routines that minimise recurrence.

Conclusion

Keloids form through a complex interplay of genetic predisposition and lifestyle triggers — from inherited collagen overproduction to environmental stressors like heat, friction, and improper wound care. While you can’t change your genes, you can control the factors that activate them.

Understanding your risks and seeking early medical intervention can make a huge difference. With modern advances in steroid therapy, laser technology, and combination treatment, it’s now possible to flatten, soften, and manage keloids safely and effectively.

If you’re struggling with persistent or recurrent keloids, trust the expertise of Dr Plus Clinic Singapore. The clinic’s doctors blend science, technology, and care to deliver smoother, clearer skin — and renewed confidence.

Book your consultation today at Dr Plus Clinic Singapore — where precision medicine meets compassionate care for every scar.