Patients with darker skin tones face delays in keloid diagnosis, doctors emphasise the need for awareness and an inclusive healthcare system
For many people, a scar is simply part of the healing process. But for others, particularly those with darker skin tones, a scar can develop into a keloid, a raised growth of scar tissue that extends beyond the boundaries of the original wound. While keloids are not cancerous, they can cause pain, itching. Keloids are often overlooked or misdiagnosed. Patients may have keloids misdiagnosed as acne, cysts or normal scars, delaying treatment and worsening symptoms. Experts say this reflects wider disparities in recognising skin conditions across different skin tones.
Condition Often Missed
Keloids can develop after minor injuries, including acne, piercings, cuts, burns and surgery. Unlike ordinary scars, they continue growing even after wounds heal. Though more common in people with darker skin, keloids can go unrecognised. Patients may spend months or years seeking a diagnosis, partly because medical training has traditionally focused on how skin conditions appear on lighter skin.
Medical training has long underrepresented darker skin tones, leaving clinicians less familiar with how skin conditions appear across diverse populations. Dr Meenu Malik, Consultant, Dermatology, Venereology and Leprology, Aakash Healthcare, says this can affect diagnosis and care.“Although keloids are more common in people with richly pigmented skin, many clinicians receive limited training in recognising dermatological conditions in these populations,” she says. “This can result in keloids being misidentified as acne-related lesions, cysts, or ordinary scars, delaying referral to a dermatologist and postponing effective treatment.” Untreated keloids can grow larger, making treatment harder and increasing discomfort, cosmetic concerns and emotional distress.
Beyond Medicine
Delayed keloid diagnosis reflects a wider healthcare disparity. Patients with darker skin may face delays in seeking care, specialist referrals and having their concerns taken seriously, slowing diagnosis and treatment. Dr. Radhika Raheja, Consultant – Dermatology & Hair Transplant at Asian Hospital, says there is increasing recognition of these inequities. “From a health-equity perspective, there is growing recognition that patients with darker skin tones often face barriers to timely diagnosis and treatment of keloids,” she says.
“While keloids are more common in individuals with richly pigmented skin, awareness and recognition of the condition are not always proportionate to the risk. Many patients report that their symptoms are initially dismissed as routine scarring, acne-related changes, or cosmetic concerns, which can delay referral to a dermatologist and postpone appropriate treatment.” Such delays may allow keloids to become larger and more symptomatic, affecting both physical comfort and quality of life.
Early treatment can help control keloids and improve outcomes. Options include steroid injections, laser therapy, cryotherapy and pressure therapy. Surgery may be combined with other treatments to reduce recurrence. Delayed diagnosis can make management harder, turning a minor skin concern into a long-term problem.
Need For Inclusive Healthcare
Experts call for greater diversity in dermatology training, with more images and case studies covering all skin tones. Dr Meenu Malik stresses that medical education and clinical resources must help doctors recognise conditions across diverse populations.
Better awareness, early diagnosis and equitable access to care can improve treatment and outcomes for keloid patients.
There is growing recognition that patients with darker skin tones often face barriers to timely diagnosis and treatment of keloids.”
Dr. Radhika Raheja, Consultant (Dermatology & Hair Transplant), Asian Hospital
