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Piercing Bump vs. Keloid: The Difference & How to Treat Each

If you're a fan of jewelry, getting a new piercing can be oh-so-exciting. But what happens if you look in the mirror to admire your bling, only to find a mysterious lump? Well, it may be a piercing bump or keloid, which can be difficult to tell apart.

Regardless of the type of piercing, finding a bump can be a bit concerning. This is totally understandable, especially if you're a piercing newbie. To help you out, we've outlined the differences between piercing bumps vs. keloids, plus what to do for each, below. 

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What is a piercing bump?

First things first: "Piercing bump" isn't a medical term. It's an informal description of what might develop after you get a piercing. That being said, there are multiple possible causes of a piercing bump.

Most commonly, a bump is a natural response to physical trauma. After all, a piercing literally injures the skin, which triggers the body's healing response. It's similar to what happens if you accidentally cut yourself with a kitchen tool, says board-certified dermatologist Loretta Ciraldo, M.D., FAAD. The bump is essentially a form of short-lived swelling, she explains, adding that it may feel tender and painful when pressed. 

In some cases, a bump might mean that the piercing is infected, especially if the surrounding skin is very red or dark (depending on your skin tone). An infected bump might also release pus or blood and develop a yellow/honey-colored crust, notes Ciraldo.  

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What is a keloid?

"The less common but more troublesome type of bump is a keloid," says Ciraldo. This is a hard and rubbery permanent scar that's caused by abnormal wound healing. Unlike a typical scar, a keloid develops beyond the initial area of injury, so it will be larger than the actual wound—in this case, the hole of a piercing. What's more, keloids can continue to grow, so they can become quite large.

To put things into perspective, keloids have three times more collagen1 (e.g., the protein that gives structure to the skin) than hypertrophic scars, or thick raised scars. They also have 20 times more collagen than healthy skin tissue. The excess collagen accumulates at the piercing site, resulting in a skin growth. Other possible keloid symptoms include itching, burning, and pain. 

You may be more likely to develop keloids if you have a darker skin tone. The same goes if you have a personal or family history of keloid formation, according to Ciraldo.

How to tell the difference between them.

If you're not sure whether you have a piercing bump or keloid, take note of three main factors: how long it lasts, where it is in the skin, and how far it spreads.

  1. Timing: According to Ciraldo, a piercing bump is a temporary area of swelling. In other words, it won't hang around forever. Instead, it will get smaller each week, often disappearing (or becoming nearly unnoticeable) after six weeks, she explains. On the flip side, a keloid is a permanent bump. It might also continue to grow over weeks, months, or years, which can happen slowly or quickly, according to the American Academy of Dermatology Association.  
  2. Placing: The lesions also differ in relation to your skin's surface. A piercing bump is under the surface of your skin, says Ciraldo, so it will only become more evident when the area is touched. Meanwhile, a keloid grows on top of the skin's surface, so it will be easily visible and palpable, she notes.
  3. Space: Finally, the "span" of a piercing bump vs. keloid is significantly different. Generally, a piercing bump is limited to the actual hole of the piercing; it might even look like a tiny flesh-colored ball underneath the earring. In contrast, a keloid will likely spread to beyond the piercing site, especially as it continues to grow. 
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How to care for a piercing bump.

If you have a piercing bump sans signs of infection, continue the usual steps for aftercare. This often means cleaning the piercing with saline and leaving it alone as much as possible. Also, if your piercer provided any specific instructions, be sure to follow them. The exact protocol might differ depending on the piercer and placement of your piercing. Additionally, according to Ciraldo, it might help to apply scar gel, which you can get at the drugstore without a prescription. The gel, which might contain a base of silicone or onion skin, may also be applied as a preventive measure—e.g., before a bump even forms.

However, if the bump hurts or develops a crust, you'll want to apply hydrogen peroxide twice a day to the area, says Ciraldo. And if it gets worse? The bump might indicate an infection. In this case, "consult a dermatologist, [as] you may need prescription topical or oral antibiotics," she notes.

How to care for a keloid.

To recap, "if you have a persistent bumpy scar, [it's] a keloid," says Ciraldo. This warrants a visit to the dermatologist, who will provide care instructions based on the keloid's size and location. For example, if you have a small keloid, your doctor might recommend applying a topical silicone gel. Other keloids might need steroid injections, which shrink the scar by breaking down excess collagen. Typically, according to Ciraldo, this "will be done in a series of injections spaced three to four weeks apart" or until the keloid shrinks or disappears. About 50 to 80% of keloids get smaller after being injected with steroids. 

A large keloid might need to be removed via surgery, according to NYU Langone Health. However, surgically removed keloids almost always come back, so this option is usually used with other treatments like steroid injections or a special dressing that places pressure on the keloid. (Pressure decreases blood flow in the area, thus preventing the keloid from redeveloping.) On that note, if the keloid is on an earlobe piercing, your dermatologist might suggest wearing a pressure earring to keep it at bay.

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When to get help.

After getting a piercing of any kind, it's a good idea to monitor your skin. You should see a dermatologist ASAP if the area develops discoloration (red or darkened skin), swelling, pain, and/or crusting, according to Ciraldo. The same goes "if you have a painless bump that has lasted more than six weeks," she adds. Such a bump might be a keloid, which is easier to control with early care and treatment.

Conclusion

In general, a piercing bump will go away after about six weeks, while a keloid is permanent. The exception is a piercing bump caused by an infection, which will get worse over time. When in doubt, visit a doctor, especially if the bump is growing quickly or releasing pus and/or blood. This will help minimize the risk of piercing complications, as well as long-term side effects.