Keloid scars are characterized by abnormal fibroproliferation and excessive extracellular matrix (ECM) production, leading to pruritus, pain, and hyperpigmentation. The pathogenesis of keloids is multifactorial, involving genetic predisposition, immune response dysregulation, and aberrant wound-healing processes. Key molecular pathways such as TGF-β/Smad and JAK/STAT play crucial roles in sustaining fibroblast activation and ECM deposition. Conventional treatments, including surgical excision, radiation, laser therapies, and intralesional injections, have variable success rates and potential side effects. Emerging therapies, such as biologics, small molecule inhibitors, RNA interference, and mesenchymal stem cell therapy, show promise in disrupting the underlying mechanisms of keloid formation, offering more effective and lasting treatment outcomes. Further research is essential to fully understand the mechanisms of keloid formation and develop targeted therapies. Ongoing clinical trials and research efforts are vital for translating scientific insights into practical treatments that can significantly improve the quality of life for individuals affected by keloid scars.Keloid scars are characterized by abnormal fibroproliferation and excessive extracellular matrix (ECM) production, leading to pruritus, pain, and hyperpigmentation. The pathogenesis of keloids is multifactorial, involving genetic predisposition, immune response dysregulation, and aberrant wound-healing processes. Key molecular pathways such as TGF-β/Smad and JAK/STAT play crucial roles in sustaining fibroblast activation and ECM deposition. Conventional treatments, including surgical excision, radiation, laser therapies, and intralesional injections, have variable success rates and potential side effects. Emerging therapies, such as biologics, small molecule inhibitors, RNA interference, and mesenchymal stem cell therapy, show promise in disrupting the underlying mechanisms of keloid formation, offering more effective and lasting treatment outcomes. Further research is essential to fully understand the mechanisms of keloid formation and develop targeted therapies. Ongoing clinical trials and research efforts are vital for translating scientific insights into practical treatments that can significantly improve the quality of life for individuals affected by keloid scars.