The Keloid Numbers Everybody Cites and Nobody Can Find

Try to trace the fifteen-times figure. I did.

It appears in patient education material, in consent discussions, in review articles, in the paragraph that explains why a particular procedure carries extra risk for Black patients. Sometimes it is fifteen times, sometimes sixteen, sometimes it is “up to sixteen percent of African Americans develop keloids.” It is never attached to a study you can open.

What you can open is a Henry Ford Hospital analysis presented at the Triological Society, looking at nearly 6,700 post-surgical patients and asking who developed a head or neck keloid afterwards. Adjusted for age and sex, African American patients had 7.1 times the odds compared with Caucasian patients.

The underlying incidence: 0.8 percent versus 0.1 percent.

And the researchers themselves flagged the gap. Their seven-fold figure, they noted, is much lower than previously reported in the medical literature, where rates of keloid development have been shown to be up to 16 percent in African Americans.

So a modern controlled surgical cohort found under one percent, and the number in circulation is sixteen. Not a small discrepancy. A factor of twenty.

One caveat belongs next to my own preferred number, or I am doing the thing this article complains about. The Henry Ford figures come from a conference presentation, reported through a press release — not a peer-reviewed paper I can send you to read. It is far better documented than the figure it displaces, which is a low bar, and it is not settled.

Why the wrong number does damage in both directions

This is the part that makes it worth writing about rather than filing under trivia.

A patient told there is a sixteen percent chance of keloiding will reasonably decline procedures that are, on the actual numbers, low risk for them. Ear piercing, a mole removal, a biopsy that should happen, a surgical repair. One in six is a coin-flip-adjacent risk. One in a hundred and twenty-five is a conversation.

Running the other way: a figure that inflated invites dismissal. A clinician who has performed hundreds of procedures on Black patients without seeing anything like sixteen percent will, quite rationally, downgrade the whole concern — including the part that is genuinely true, which is that the relative risk is sevenfold and that it concentrates at particular sites.

And site is where the real information is. Keloids are not evenly distributed across the body. Ear lobes, the presternal chest, shoulders, the jawline and the upper back are the classic high-tension, high-risk locations; a keloid on the lower leg is uncommon. A risk figure with no anatomy attached to it is not usable.

The number that is not disputed

Excision alone recurs at 70 to 100 percent.

That range is repeated consistently across the surgical literature — and, like the sixteen percent, it is repeated more often than it is sourced. The difference is that every version of it agrees, and that it is being used to talk you out of something rather than into it, which is the direction in which an unsourced number does the least harm.

It is also the single most useful fact on this page, because it changes what you should say yes to. Cutting a keloid out, by itself, with nothing else, fails almost always — and often returns larger than the original, because you have added a fresh high-tension wound to a body that produces keloids.

Which means “we can just remove it” is the wrong answer and a fairly reliable signal about the person offering it. The approaches with better recurrence figures are combinations: excision with adjuvant intralesional steroid, with pressure, with silicone, or with radiotherapy in selected cases. What matters is that something is added, and what you want from a consultation is the word “and.”

What to do with your own history

You have better data than the literature does, and it is on your body.

Find an old piercing, a vaccination scar, a childhood cut, a surgical site. A flat pale line is a flat pale line. A firm raised ridge that spread beyond the boundaries of the original wound and kept going for months is a keloid, and it is worth knowing which sites on you have produced one and which have not, because the answer is frequently site-specific rather than general.

A hypertrophic scar — raised, but staying within the original wound, and flattening over a year or two — is a different thing and gets confused with keloid constantly, including by people who should know better. The distinction is whether it spread past the edges.

One personal keloid at one site is more predictive than any ancestry-based percentage. Two at different sites is a reason to have the conversation before every elective procedure, permanently.

And nought, at forty, across several piercings and a couple of decent scars, is also information. It does not make you immune. It makes the sixteen percent figure even less relevant to you than it was.

This article is educational and is not a substitute for care from someone who can look at your skin. Anything new, changing, painful or spreading should be assessed rather than researched.