This review discusses pharmacotherapy for keloids (KD) and hypertrophic scars (HTS), focusing on treatment options that aim to improve patients' quality of life (QOL). KD and HTS are raised, pigmented scars with increased vascularization and cellularity, often caused by impaired healing in individuals with genetic predispositions. These scars can cause pain, itching, and cosmetic issues, significantly affecting QOL. Treatment options include monotherapy with a single drug, combination therapy with multiple drugs, and combinations with surgical excision or physical therapies like cryotherapy, laser therapy, and silicone gel sheeting. Pharmacotherapy involves drugs administered orally, topically, or via intralesional injection. While clinical results for individual drugs are inconsistent, combination therapies targeting multiple sites are more effective. Drugs such as ACE inhibitors (e.g., captopril, enalapril, losartan), antiallergic agents (e.g., tranilast), antisense drugs (e.g., TGF-β1, SMAD3, TERT antisense oligodeoxynucleotides), interferons, calcium antagonists (e.g., verapamil), chemotherapeutics (e.g., bleomycin, 5-fluorouracil, mitomycin C, paclitaxel, tamoxifen), and fat-soluble vitamins (e.g., vitamin A, D3, E) have shown promise in treating KD and HTS. ACE inhibitors reduce fibroblast proliferation and collagen production, while antiallergic agents like tranilast inhibit collagen and TGF-β1 expression. Antisense drugs target specific genes involved in fibrosis. Interferons suppress collagen synthesis, and calcium antagonists inhibit ECM protein synthesis. Chemotherapeutics like bleomycin and 5-fluorouracil induce apoptosis in fibroblasts. Fat-soluble vitamins support wound healing and reduce fibrosis. Combination therapies, including physical therapies and surgical excision, are often more effective than single-drug treatments. However, the effectiveness of these treatments varies, and further research is needed to determine the most effective and safe approaches for KD and HTS management.This review discusses pharmacotherapy for keloids (KD) and hypertrophic scars (HTS), focusing on treatment options that aim to improve patients' quality of life (QOL). KD and HTS are raised, pigmented scars with increased vascularization and cellularity, often caused by impaired healing in individuals with genetic predispositions. These scars can cause pain, itching, and cosmetic issues, significantly affecting QOL. Treatment options include monotherapy with a single drug, combination therapy with multiple drugs, and combinations with surgical excision or physical therapies like cryotherapy, laser therapy, and silicone gel sheeting. Pharmacotherapy involves drugs administered orally, topically, or via intralesional injection. While clinical results for individual drugs are inconsistent, combination therapies targeting multiple sites are more effective. Drugs such as ACE inhibitors (e.g., captopril, enalapril, losartan), antiallergic agents (e.g., tranilast), antisense drugs (e.g., TGF-β1, SMAD3, TERT antisense oligodeoxynucleotides), interferons, calcium antagonists (e.g., verapamil), chemotherapeutics (e.g., bleomycin, 5-fluorouracil, mitomycin C, paclitaxel, tamoxifen), and fat-soluble vitamins (e.g., vitamin A, D3, E) have shown promise in treating KD and HTS. ACE inhibitors reduce fibroblast proliferation and collagen production, while antiallergic agents like tranilast inhibit collagen and TGF-β1 expression. Antisense drugs target specific genes involved in fibrosis. Interferons suppress collagen synthesis, and calcium antagonists inhibit ECM protein synthesis. Chemotherapeutics like bleomycin and 5-fluorouracil induce apoptosis in fibroblasts. Fat-soluble vitamins support wound healing and reduce fibrosis. Combination therapies, including physical therapies and surgical excision, are often more effective than single-drug treatments. However, the effectiveness of these treatments varies, and further research is needed to determine the most effective and safe approaches for KD and HTS management.