Keloids (KD) and hypertrophic scars (HTS) are raised, pigmented, and highly vascularized scars that form due to impaired healing processes in individuals with genetic predispositions. These scars significantly reduce patients' quality of life (QOL) due to pain, itching, contracture, and cosmetic issues. Treatment options, including pharmacotherapy, are still under development. This article reviews pharmacotherapy for KD and HTS, including prevention of postsurgical recurrence. Pharmacotherapy involves monotherapy with a single drug or combination therapy with multiple drugs administered orally, topically, or through intralesional injections. Combining pharmacotherapy with physical therapies such as cryotherapy, laser therapy, radiotherapy, and silicone gel/sheeting can enhance effectiveness. The clinical effectiveness of mono-pharmacotherapy varies among researchers, but multimodal combination therapy is more effective. The literature was searched using PubMed, Google Scholar, and online search engines. The biological properties of KD and HTS differ, with KDs growing beyond the original wound margins and HTSs remaining within them. KDs are associated with genetic factors and are more common in certain ethnicities, while HTSs are influenced by systemic and local factors. Treatment options include ACE inhibitors, antiallergic agents, antisense drugs, antiviral cytokines, calcium antagonists, chemotherapeutics, fat-soluble vitamins, immunomodulators, and others. Each drug type has specific mechanisms of action, such as suppressing fibrosis-enhancing cytokines and ECM production. Clinical trials and case studies have shown varying degrees of efficacy and safety for these treatments, with some drugs showing promise in reducing scar size, vascularity, and pliability.Keloids (KD) and hypertrophic scars (HTS) are raised, pigmented, and highly vascularized scars that form due to impaired healing processes in individuals with genetic predispositions. These scars significantly reduce patients' quality of life (QOL) due to pain, itching, contracture, and cosmetic issues. Treatment options, including pharmacotherapy, are still under development. This article reviews pharmacotherapy for KD and HTS, including prevention of postsurgical recurrence. Pharmacotherapy involves monotherapy with a single drug or combination therapy with multiple drugs administered orally, topically, or through intralesional injections. Combining pharmacotherapy with physical therapies such as cryotherapy, laser therapy, radiotherapy, and silicone gel/sheeting can enhance effectiveness. The clinical effectiveness of mono-pharmacotherapy varies among researchers, but multimodal combination therapy is more effective. The literature was searched using PubMed, Google Scholar, and online search engines. The biological properties of KD and HTS differ, with KDs growing beyond the original wound margins and HTSs remaining within them. KDs are associated with genetic factors and are more common in certain ethnicities, while HTSs are influenced by systemic and local factors. Treatment options include ACE inhibitors, antiallergic agents, antisense drugs, antiviral cytokines, calcium antagonists, chemotherapeutics, fat-soluble vitamins, immunomodulators, and others. Each drug type has specific mechanisms of action, such as suppressing fibrosis-enhancing cytokines and ECM production. Clinical trials and case studies have shown varying degrees of efficacy and safety for these treatments, with some drugs showing promise in reducing scar size, vascularity, and pliability.