Keloids versus HT scarring

This will be my last post before the official Christmas holiday, and I’ll have more up shortly after the New Year. Merry Holidays, everyone!

There has been some debate recently over what is a keloid and what is hypertrophic scarring on piercings. So, let’s find out the difference, shall we? It’s very important that you recognize the difference between the two and know how to treat them because, unfortunately, many piercers don’t even know.

First, the definition of each. In the sense of body piercings:

Keliod: an abnormal scar that grows beyond the boundaries of the original site of skin injury.
Hypertrophic scarring: a widened or unsightly scar that does not extend beyond the original boundaries of the wound.

Contrary to popular belief, not every lump or bump on a piercing is a keloid, it is not a general term for piercing growth abnormalities of any kind. Keloid scars are actually very rare, while hypertrophic scarring, or HT scarring for short, is much more common. Keloids extend far beyond the initial injury site, becoming a raised amorphous growth, and are usually painful. These will be huge growths taking over the area well beyond the area that was pierced to begin with. They are also much more common in dark skinned people than they are in light skinned people.

These are keloid scars:

Keloid scars can form the same way other scars can, but what exactly causes a keloid isn’t really known. Trauma to the area, infections, foreign bodies in the wound, or excessive tension and movement can all contribute to the formation of keloid scars. Certain areas of the body such as the sternum and chest, the upper arm, the ears, and upper back have an increased chance to develop keloid scars. These areas also go through a lot of muscle and skin tension and movement, which can encourage the growth of keliod scars.

The best way to treat an actual keloid is to have it cut off and removed by a doctor or dermatologist, since they can be recurring without proper treatment, removal and aftercare. Some may also recommend steroid injection treatments, which can only be prescribed and performed by a doctor or dermatologist. There are no home remedies to cure a full blown keloid.

Hypertrophic scarring, or HT scarring for short, is actually much more common. It is also called the “piercing bump, piercing pimple, or piercing lump”. Unlike keloids, HT scarring doesn’t continue to grow beyond the initial wound site, and once it reaches a certain level or height it will usually stop and just remain there. They can sometimes be painful, but are more sore than actually painful. Hypertropic scars are usually raised a bit, usually reddish in color, but don’t go beyond the original wound.

This is Hypertrophic, or HT, scarring:

These scars, at least on piercings, are caused by trauma to the piercing, sleeping on it, pulling on it, constant movement of jewelry, etc. They can also be caused by metal allergies. The first step in treating HT scarring is to figure out what’s causing it, and rectify that. If you’re wearing rings in your piercing, switch them out for barbells instead since barbells do not allow for movement the way rings do. Do not sleep on the side that your piercing is on, be very aware that you are not catching the jewelry on a hairbrush, earphones, you’re not playing with it, etc. If you think you may be having metal allergy reactions, switch the jewelry for something non-metallic, or opt for titanium or niobium, if you must wear metal, since both contain no nickel.

There are two most effective treatments for HT scarring, and both are very easy to do. The first one is Tea Tree oil. This amazing oil does everything; it’s antiviral, antibacterial, antifungal, and antiseptic. It can even help treat acne. However, some find that direct undiluted applications of Tea Tree oil can cause allergic reactions on their skin. So, before treating HT scarring on piercings, do a test patch on your skin. Dab straight oil onto the underside of your wrist or elbow, and leave for 24-48 hours. If no reaction occurs, you should be just fine to use it.

For the purposes of treating HT scarring, dab Tea Tree oil onto the scar after every sea salt soak you perform each day. If you would like to dilute the oil, you may do so with another carrier oil, do not mix with water (remember 3rd grade science, everyone, you can’t mix oil and water!). A great oil to mix with Tea Tree is Jojoba or Vitamin E, both of which will also help keep your skin from drying out from the Tea Tree oil. Continue to apply the oil until the scarring disappates, this can take weeks or even months depending on the severity of the scarring, how long it’s been there, and what you’re doing to stop it from recurring. As the oil starts to take effect, it will dry out the scarring cause it to peel away. Do not pick at the peeling skin. Continue salt soaks and Tea Tree oil treatments until the scarring is completely gone. Mixing the Tea Tree with a carrier oil, like Jojoba or Vitamin E, can help prevent the drying out of the skin, but can also make treatment take longer. Once the oil is on, do not wipe it off, do not wash it off, just leave it alone to air dry.

A few words of warning about Tea Tree oil, however. It is considered toxic if consumed, so do not use this method for inside of the mouth treatments. It is also deadly to cats, so keep it locked away from your furry friends. Do not purchase Tea Tree oil if it is not in a black or dark brown glass bottle, since sunlight can degrade the oil. The best way to get it is in its organic, pure, essential oil formula, and it is available nearly everywhere. You can get it from grocery stores, drug stores, health food and supply stores; I have never not found it when I’ve been looking.

The second method is the aspirin paste method. Crush one plain, uncoated aspirin tablet as finely as you can. You can also sometimes find aspirin powder in small packets, this works just as well, just use one packet as you would for one pill. Add a single drop of water at a time to the powder or crushed pill until it forms a paste. Apply this paste to the scarring, allow it to air dry for about 5 to 7 minutes, and then rinse off. This method is safe for inside of the mouth treatments, it just doesn’t taste very good. This is also known as an effective spot treatment for pimples and acne.

And so with that out of the way, I wish everyone safe and sane Holidays to come. Eat lots, drink lots (if you’re of age), and be very merry, indeed. I wish everyone a safe and happy New Year, and hope everyone gets everything they want this gift-giving season.


6 Comments (+add yours?)

  1. Kou
    Dec 14, 2011 @ 19:58:10

    I’m so glad you’re writing this blog, Laura. We need more intelligent advice out there. You’re the best. ❤


  2. tasha
    Jun 15, 2012 @ 16:53:12

    Thank u, I had no idea what was going on with my cheek peircing!!
    You are theee besttt!!!


  3. Maya
    Aug 02, 2013 @ 01:36:45

    Would it be okay to just take the piercing out ?


  4. Deepak Rajput
    May 01, 2015 @ 02:32:45

    please explain me what do you mean by sea salt soak before applying tea tree oil onto the scar. My 5 year old daughter had pierced her ears a month back and now a HT scar (with no pain symptoms) appears on one of his ear. she has also removed his ring now from ear. How do we know that this is due to metal reaction or an injury?


    • Steel and Bone, Horn and Stone
      May 01, 2015 @ 12:53:10

      It could be either or. HT scarring is caused by trauma or irritation to the piercing. This can come from metal allergies, injury from yanking on it, sleeping on it, hair brushes, clumsy fingers, any number of things.

      A month old is still too new to use the tea tree oil method. It’s VERY drying and potentially irritating to new piercings, new meaning anything still in the initial healing phase. For earlobes, that’s a good 3-4 months. Refer to the Piercing Aftercare post for a full explanation of how a sea salt soak is done. After that, you can use a chamomile tea bag soak. Just take a bag of chamomile tea, steep it in warm water, then compress to the area, re-dipping in warm water as necessary. That is the least-irritating method of treating HT scarring, but it can also take a while to show effect, so don’t give up if changes aren’t immediate. It can also take longer now that the jewelry has been removed and the fistula allowed to close.


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