Current and Emerging Strategies in the Management of Keloid Scars: A Comprehensive Review

Abstract

Keloids represent a pathological wound-healing process distinct from normal and hypertrophic scarring and characterized by invasion beyond wound borders, associated pain and pruritis, and high recurrence rate despite multimodal treatment. Current therapeutic options aim to target the mechanisms that underlie this aberrant immunological response. Conservative management, such as pressure therapy, silicone-based modalities, and topical agents, has historically been used as the first-line treatment option often in combination with steroid injections. More invasive approaches such as surgical excision, coupled with radiation therapy or other repurposed chemotherapeutic agents, are sometimes warranted if an inadequate clinical response persists. Despite a wide range of treatment options, keloids and hypertrophic scars remain difficult to manage, and response is generally dependent on patient-specific factors, scar location, or etiology. Novel therapies, including calcium-channel blockers and mesenchymal stem cells, have accelerated development in this field of study, though further investigation is needed to elucidate the most effective and accessible application of these investigative treatments. This review aims to provide a comprehensive summary of available treatment strategies and their shortcomings, including specific recommendations on dosage and duration when available.