Keloid scars are abnormal fibrous growths that extend beyond the original wound, causing symptoms like pain, itching, and hyperpigmentation. They are influenced by genetic factors, immune responses, and abnormal wound healing. Key molecular pathways, such as TGF-β/Smad and JAK/STAT, play a central role in their formation by promoting fibroblast activation and excessive extracellular matrix (ECM) production. Conventional treatments, including surgery, radiation, laser therapy, and intralesional injections, have variable success but are limited by high recurrence rates and side effects. Emerging therapies targeting immune pathways, small molecule inhibitors, RNA interference, and mesenchymal stem cells show promise in disrupting keloid pathogenesis. Despite advancements, further research is needed to fully understand the mechanisms and develop more effective treatments. Current treatments include silicone dressings, corticosteroids, cryotherapy, surgery, radiation, and laser therapies, each with varying efficacy and side effects. Emerging therapies focus on molecular pathways to reduce fibroblast proliferation and ECM production, offering potential for more effective and lasting outcomes. Continued research is essential to improve keloid management and enhance the quality of life for affected individuals.Keloid scars are abnormal fibrous growths that extend beyond the original wound, causing symptoms like pain, itching, and hyperpigmentation. They are influenced by genetic factors, immune responses, and abnormal wound healing. Key molecular pathways, such as TGF-β/Smad and JAK/STAT, play a central role in their formation by promoting fibroblast activation and excessive extracellular matrix (ECM) production. Conventional treatments, including surgery, radiation, laser therapy, and intralesional injections, have variable success but are limited by high recurrence rates and side effects. Emerging therapies targeting immune pathways, small molecule inhibitors, RNA interference, and mesenchymal stem cells show promise in disrupting keloid pathogenesis. Despite advancements, further research is needed to fully understand the mechanisms and develop more effective treatments. Current treatments include silicone dressings, corticosteroids, cryotherapy, surgery, radiation, and laser therapies, each with varying efficacy and side effects. Emerging therapies focus on molecular pathways to reduce fibroblast proliferation and ECM production, offering potential for more effective and lasting outcomes. Continued research is essential to improve keloid management and enhance the quality of life for affected individuals.