Keloids vs. Piercing Bumps: How to Tell What You're Dealing With, According to Derms

Back view of a model with Bantu knots, showing of four ear piercings.

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There's nothing quite like the rush of getting a new body or ear piercing. But even if you're extremely diligent about the piercing healing process, an angry, scar-like bump can rear its head immediately or a few months in. And while you may automatically assume it's an infection, there are two other possibilities: keloids or piercing bumps.

While piercing bumps appear at the site of a piercing (as the name suggests), keloid scars don't just occur after a piercing, In fact, there are several reasons they might appear that don't even involve going under the needle. But what exactly is a keloid, and how do you know if you have one? We asked top dermatologists Shari Sperling, DO, Jennifer MacGregor, MD, and Brenden Camp, MD, what causes keloid scars and how they differ from piercing bumps.

Ahead, find everything you need to know about keloids and piercing bumps before hitting the piercer's chair.

Meet the Expert

  • Brendan Camp, MD, is a double board-certified dermatologist specializing in medical and cosmetic dermatology at MDCS Dermatology in New York City.
  • Jennifer L. MacGregor, MD, is a board-certified dermatologist at Union Square Laser Dermatology. She has training in cutaneous laser surgery and dermatologic procedures. MacGregor is currently an Assistant Clinical Professor of Dermatology at the Columbia University Medical Center.
  • Shari Sperling, DO, is a board-certified dermatologist specializing in medical, cosmetic, laser, and surgical dermatology. Practicing in Florham Park, New Jersey, she is the founder and owner of Sperling Dermatology.

What Is a Keloid?

A keloid is a type of raised scar that occurs when the skin has healed after a wound. According to Sperling, the scar appears thickened and sometimes pink or flesh-colored. Extra scar tissue grows after the injury, forming a smooth, hard-raised area.

Keloids can range in size and can sometimes cause itching or tenderness. "Keloids are abnormal, inflamed scars that grow beyond the border of the original injury and continue to grow in thick lines, bumps, or even tumor-like nodules," says MacGregor. "Keloids can also develop after bug bites, acne, and other seemingly mild skin injuries. In rare cases, keloids develop spontaneously without recalled trauma."

What Causes Keloids?

Keloids grow because the body over-defends itself due to physical trauma, surgery, or injury to the skin. They are common for people under the age of 30. According to Sperling and MacGregor, African Americans are more likely to get keloids. It is best to avoid scarring to the skin by opting out of piercings, tattoos, elective surgeries, and some laser procedures. "Darker skin types are much more prone to keloid scarring and should make every effort to minimize unnecessary and preventable trauma to the skin," says MacGregor.

"Keloids are associated with young adulthood and are (at least partly) hereditary. While the cause is not completely understood, there is evidence that several factors play a role in keloid development such as abnormal wound healing, abnormal blood vessel signaling, inflammation, deeper skin injuries, and mechanical stress," MacGregor adds.

What Is a Piercing Bump?

A piercing bump represents an overproduction of granulation tissue. "Granulation tissue is made by the body after an injury, such as a piercing. It is composed of blood vessels and other tissue the body makes as it heals," according to Camp.

What Causes a Piercing Bump?

Piercing bumps are caused by the body's immune system responding to the wound from the piercing, causing some localized inflammation. "The body’s overproduction of healing tissue causes a bump to form around the piercing," Camp says.

Keloids vs. Piercing Bumps

Keloids are thick, raised scars that occur during an injury-healing process, while piercing bumps are bumps of granulation tissue that represent the body's immune system responding to a wound from a piercing. According to the experts, there are a few ways to tell the difference between keloids and piercing bumps:

  • Time of formation: If the bump appears soon after you get a piercing, it's more likely to be a piercing bump, as keloids typically take a few months to form.
  • Size: Keloids often start small, growing over time, while piercing bumps stay the same size after forming.
  • Location: As the name suggests, piercing bumps solely appear on or near the piercing site. Keloids can appear around a piercing and on other body spots where an injury has occurred.
  • Reaction to jewelry removal: Piercing bumps tend to disappear after removing the jewelry at the affected spot, while the removal of jewelry will not affect a keloid.

Can You Prevent Keloids?

If you want to prevent keloids from developing in the first place, MacGregor suggests looking into your family history or personal history of keloids to prevent skin trauma or injury. If you are prone to keloids, piercings and tattoos are strongly discouraged. There's no limit to where keloids can form, as they can grow on the tongue and other mucus membranes. If you decide to risk a tattoo or piercing, be aware that you may end up with excessive scarring and/or keloids.

Irritants like oil, sweat, dirt, perfume, hairspray, and other things can aggravate a piercing and cause an infection. Unfortunately, it also won't respond very well to normal cleaning (although it's important to keep it clean so it doesn't get worse). The upside to this kind of bump is that it's easily treatable at home by performing proper piercing aftercare. If it doesn't clear up in a few days, though, you should see your doctor.

"If one was to have a cosmetic concern on the face and it is not medically necessary to remove, someone with a history of keloids may opt not to do the procedure as a way to prevent the formation of a keloid," says Sperling.

How to Treat Keloids 

Treatments for keloids should be initiated at the first sign (before it becomes a hard rock or a lump). "Keloids are much easier to treat and keep at bay if in-office treatment is initiated right away at the first sign of scar thickening," MacGregor says.

Cortisone Injections

According to Sperling, "Cortisone injections done monthly of varying strengths can be used to help flatten them." In-office treatments injections with cortisone are adjusted depending on how thick or large the keloid is.

Sea Salt Soak

In general, to prevent any and all issues, you're going to want to listen to your piercer's instructions. Sea salt soaks, which any responsible piercer will tell you to do, are meant to draw out any pus and blood, releasing the pressure and aiding healing. They also tend to be soothing.

It is recommended to cleanse the area twice a day with a piercer-recommended saline solution like H2Ocean ($17) and then use a non-scented, antimicrobial, dye-free soap like Naked Soap ($12). Sticking to that simple process will increase your chances of healing the infection without causing further irritation.

Silicone Gel/Sheets

Both Sperling and MacGregor agree that silicone is an important gel to use. "Place the silicone gel or sheets continuously (for 24 hours) to cover the scar and surrounding skin. Gentle massage also provides a mild benefit once the scar is healed," notes MacGregor. "Minimize movement pulling or stress to the area as physical compression wraps or garments can help reduce motion in mobile areas." The silicone sheets can be used on healed scars as well.

Laser Removal

Once a keloid occurs, vascular lasers can be used every three to four weeks. "Pulsed dye and long-pulsed Nd:YAG lasers reduce abnormal signals/stop the proliferation of keloidal fibroblast cells in hypertrophic (thickened) scars and keloids. Deep or thick nodules can be reduced with a combination of injections, vascular lasers, fractional resurfacing lasers, and laser-assisted delivery of 5-fluorouracil/corticosteroids," MacGregor explains. In severe or extreme cases, debulking surgeries or even radiation might be needed. "If the keloid is debulked with surgery, all of the above treatments are still needed on an ongoing basis so the keloid stays at bay or controlled." 

When You Should See a Doctor 

"At the first sign of thickening, firm bumps, redness, tender or raised areas within a scar—see a dermatologist or your surgeon. Do not delay treatment. Do not initiate treatment and fail to follow up (every six to eight weeks) to keep the scar as soft and flat as possible," MacGregor warns.

When the area around your piercing hurts, oozes pus, and/or bleeds, it's not a keloid; it's probably either an infection or an epidermal inclusion cyst. While not malignant, these cysts will usually be little more than an annoyance and sometimes go away on their own. Normally, they're painless, but they can rupture or get infected. They are easy for your doctor to diagnose but usually have to be removed surgically, or the cyst may recur. If you think you have an epidermal inclusion cyst, the best thing to do is see your doctor and follow their recommendation—and despite all urges, don't touch it.

"If you have a history of keloids, you should make your provider know this prior to any skin procedures so that precautions can be taken to avoid keloid production," advises Sperling.

The Takeaway

Keloids are thick scars caused by injuries while piercing bumps are bumps caused by the reaction of the immune system to the wound of a piercing. While piercing bumps can be avoided by not getting a piercing and treated by removing the piercing, keloids are not preventable—only avoidable if you research your personal and family history. If you have a wound, take care of it immediately. Add ointment and non-sticking dressing, and completely protect your skin from the sun.

Knowing the risks attached to a piercing or tattoo before scheduling is important, as it can result in scarring. "Keloids can’t be ‘removed’ because new scar tissue wants to grow in the area constantly usually until it ‘burns out.' Eventually, it will slow down and stop growing but this can take years," MacGregor states. Some scars will remain and it is a personal choice whether you want to remove them or not. Be sure to seek a professional opinion on bumps and raised scars. The earlier, the better.

Article Sources
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  1. American Academy of Dermatology Association. Signs and symptoms.

  2. Koike S, Akaishi S, Nagashima Y, Dohi T, Hyakusoku H, Ogawa R. Nd:YAG laser treatment for keloids and hypertrophic scars: an analysis of 102 casesPlast Reconstr Surg Glob Open. 2015;2(12):e272. doi:10.1097/GOX.0000000000000231

  3. Cleveland Clinic. Sebaceous cysts. Updated January 15, 2021.

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