Keloid removal works best as a plan, not a single procedure. Most keloids are first treated with steroid or 5-FU injections and sometimes cryotherapy. Large or stubborn keloids can be cut out, but excision alone comes back in 45% to 100% of cases, so surgery is paired with steroid injections, pressure, or radiation started within a few days. Insurance often helps when the keloid hurts, itches, or limits function, because many plans treat symptomatic keloids as a medical problem rather than a cosmetic one.
A keloid is an overgrowth of scar tissue. After a cut, piercing, surgery, burn, or acne bump, the skin’s repair process does not switch off. The scar keeps growing and spreads past the edges of the original wound, often into a firm, shiny, rubbery lump that can be pink, red, purple, or darker than the surrounding skin.
A hypertrophic scar looks similar at first. It is also thick and raised, but it stays within the borders of the original wound, and it often softens and flattens on its own over one to two years. Keloids usually do not regress without treatment, and they can keep enlarging for years.
Medical coders file both under the same diagnosis code, ICD-10 L91.0 (hypertrophic scar, which includes keloid). Insurers such as Aetna and Anthem list L91.0 as a supporting diagnosis for keloid treatment. Acne keloids have their own code, L73.0.
Keloids show up most often where skin is under tension or where small injuries are common:
Risk is not equal across people. Keloids are much more common in skin of color: the NCBI Textbook on Scar Management reports incidence of roughly 4.5% to 16% in people of African descent, compared with under 1% in some Caucasian and Taiwanese Chinese groups. A family history of keloids raises the odds too, and anyone who has formed one keloid is more likely to form another.
A keloid is not only a cosmetic concern. In one study of keloid patients (Lee et al., 2005), 86% reported itching and 46% reported pain. Common complaints include:
See a doctor promptly if a growth appears without any known injury, grows quickly, bleeds without a reason, or looks different from your other scars. A changing lump may need a biopsy. Our lump and bump removal page explains how we evaluate new skin growths.
Expert guidelines such as the Japan Scar Workshop Consensus start with the least invasive options and reserve surgery plus an added therapy for resistant or large keloids.
Injecting a corticosteroid (usually triamcinolone) directly into the keloid is the standard first step. It flattens the scar and often calms itching within a few sessions. 5-fluorouracil (5-FU) can be injected alone or mixed with the steroid. Combination therapy gives better height reduction and lower recurrence than either drug alone. Side effects can include skin thinning or lightening, so doses are adjusted carefully.
Freezing can shrink small, raised keloids, alone or with injections. Because cold can lighten pigment, it is used cautiously on darker skin.
Silicone and pressure soften raised scars and matter after any keloid surgery. Pressure earrings, worn many hours a day for months, are key after earlobe keloid removal.
For a large keloid, one that has not responded to injections, or an earlobe keloid, surgery may be the best choice. The keloid is cut out and closed carefully in layers. What matters most is experience with keloids and a clear plan to prevent recurrence.
The key point is that excision alone recurs in 45% to 100% of cases. That is why surgery is almost always followed by an adjuvant, meaning an added treatment to keep the keloid from returning:
A meta-analysis by Mankowski and colleagues (Annals of Plastic Surgery, 2017; 72 studies and 9,048 keloids) found recurrence of about 22% after excision plus radiation, compared with 37% for radiation used alone. Radiation works best when started soon after closure, which is why insurers set windows of 3 to 7 days.
Health plans generally treat a keloid as a medical problem when it causes pain, itching, bleeding, or a functional limitation and has been documented in your chart. Our guide on when insurance covers scar revision explains the general rules. Here is how they apply to keloids specifically:
California adds another path. Fully insured California plans and Medi-Cal must cover reconstructive surgery that creates “a normal appearance, to the extent possible” for abnormal structures caused by trauma, surgery, infection, or disease. A disfiguring keloid can qualify even without a functional problem, although a plan may still deny a request if it expects only minimal improvement. Self-funded employer (ERISA) plans are not bound by this state law, so always confirm how your plan is funded.
Even when the keloid is covered, some treatments are not. Aetna lists many keloid and scar treatments as experimental, including botulinum toxin (Botox) injections, bleomycin, verapamil, interferon, PRP, microneedling, and silicone products billed as a separate item. Cigna’s scar policy takes a similar position. Our fees and financing page explains payment options for treatments your plan does not cover.
To build a strong request, keep a record of how the keloid started, your itch and pain scores, and the dates of every treatment you have tried, and ask for measured color photos. If your keloid started after an accident or assault, the costs may also be part of an injury claim. See our personal injury care in Los Angeles page.
Sometimes, but no doctor can promise it. Excision alone comes back in 45% to 100% of cases. Combining surgery with steroid injections, pressure, or radiation started within a few days lowers that risk substantially, to about 22% with post-excision radiation in one large meta-analysis.
Often, when the keloid causes pain, itching, bleeding, or a functional problem and that is documented. Aetna covers keloid repair that causes pain or functional limitation, and Aetna and Anthem cover radiation after excision within set time windows. In California, a disfiguring keloid may also qualify under the state’s normal-appearance rule on fully insured plans and Medi-Cal.
A hypertrophic scar is thick and raised but stays inside the original wound and often flattens over one to two years. A keloid grows beyond the wound edges, rarely shrinks on its own, and is more likely to return after surgery.
Most keloids need a series of injections spaced several weeks apart. The number depends on the size and thickness of the keloid and how it responds. Your doctor will reassess after each session and may add 5-FU if progress stalls.
Radiation is meant to stop the scar-forming cells before they rebuild the keloid. It works best right after the incision is closed. Insurers reflect this: Aetna requires radiation to begin within 7 days and Anthem within 3 days of excision.
It is usually not recommended. People who have formed one keloid are more likely to form another, and a new piercing can restart the process. Talk with your surgeon before any new piercing, tattoo, or elective procedure.
If a keloid is itching, hurting, or growing, you do not have to live with it. Dr. Moeinolmolki can examine the keloid, map out a treatment and recurrence-prevention plan, and help document what your insurer needs. Read our scar revision insurance guide to see how plans decide, then book a scar evaluation or call (310) 455-8020.
Medically reviewed by Dr. Babak Moeinolmolki, MD, FACS, double board-certified through the American Board of Surgery and the American Board of Cosmetic Surgery, practicing in Los Angeles. Reviewed October 2026. This article is for education and is not a substitute for an in-person evaluation or a coverage decision from your health plan.
