The article reviews the pathomechanisms and current and emerging treatment strategies for hypertrophic scarring and keloids. Hypertrophic scars and keloids are excessive scars that form due to aberrations in the physiologic wound healing process, causing pain, pruritus, and contractures. The review highlights the clinical, histological, and epidemiological differences between hypertrophic scars and keloids, emphasizing the importance of accurate diagnosis for appropriate management. The physiologic response to wounding is divided into three phases: inflammation, proliferation, and remodeling. Abnormalities in these phases lead to excessive scar formation. Key factors include the imbalance between anabolic and catabolic phases, altered fibroblast phenotype, and the role of growth factors like TGF-β. Treatment strategies include prophylaxis with pressure therapy and silicone gel sheeting, as well as various therapeutic approaches such as intralésional corticosteroid injections, cryotherapy, surgical excision, radiotherapy, laser therapy, and emerging therapies like interferon injections, bleomycin, and 5-fluorouracil. Despite extensive research, the exact mechanisms of scar formation remain poorly understood, and more studies are needed to develop effective treatments.The article reviews the pathomechanisms and current and emerging treatment strategies for hypertrophic scarring and keloids. Hypertrophic scars and keloids are excessive scars that form due to aberrations in the physiologic wound healing process, causing pain, pruritus, and contractures. The review highlights the clinical, histological, and epidemiological differences between hypertrophic scars and keloids, emphasizing the importance of accurate diagnosis for appropriate management. The physiologic response to wounding is divided into three phases: inflammation, proliferation, and remodeling. Abnormalities in these phases lead to excessive scar formation. Key factors include the imbalance between anabolic and catabolic phases, altered fibroblast phenotype, and the role of growth factors like TGF-β. Treatment strategies include prophylaxis with pressure therapy and silicone gel sheeting, as well as various therapeutic approaches such as intralésional corticosteroid injections, cryotherapy, surgical excision, radiotherapy, laser therapy, and emerging therapies like interferon injections, bleomycin, and 5-fluorouracil. Despite extensive research, the exact mechanisms of scar formation remain poorly understood, and more studies are needed to develop effective treatments.