Therapeutic methods and effect on keloid and hypertrophic scars: A systematic review

Yuhang Shen¹Lirong Yang²Dayong Feng³Chunhui Wang¹Zhiyong Bai¹Xi Wang¹Jingwen Wang¹Yuening Feng^1*Ayue An^1*

• ¹Department of Anorectal, Wangjing Hospital, China Academy of Chinese Medical Sciences, Beijing, China
• ²Department of Surgery, Central University of Finance and Economics (Shahe Campus) School Hospital, Beijing, China
• ³Department of Anorectal, Wangjing Hospital，China Academy of Chinese Medical Sciences, Beijing, China

Background Keloids and hypertrophic scars are fibroproliferative disorders with high recurrence rates, lacking a definitive treatment standard. This review systematically evaluates current therapies and their effectiveness for keloid and hypertrophic scar treatment. Method The inclusion criteria were based on the population, intervention, comparator, outcomes, and study design (PICOS) framework. Electronic searches through April 2025 in databases like PubMed, EMBASE, Cochrane Library, and Web of Science utilized keywords such as ‘keloid’, ‘occlusive dressings’, and ‘imiquimod’, among others. Meanwhile, we use the keywords 'Antigens, CD' and 'MicroRNAs' to search for molecular mechanisms associated with keloid and hypertrophic scars. The Risk Of Bias 2 (RoB2) and Methodological Index for Non-Randomized Studies (MINORS) checklists were used to assess quality problems and possible bias of the included studies. Results This study synthesizes findings from 162 studies, exploring a range of treatments including monotherapies and combination therapies—such as local corticosteroid injections, optical therapy, radiation therapy, 5‑fluorouracil (5‑FU) therapy, bleomycin therapy, verapamil therapy, excision surgery, cryotherapy, and topical treatments, various multi-drug regimens, as well as innovative therapies such as stem cells and the RNA microneedle. Technological developments continue to expand available interventions. Treatment strategies increasingly emphasize combination therapies—integrating intralesional corticosteroids, surgical excision, laser modalities, and radiotherapy—which demonstrate superior outcomes compared with single‑modality approaches, notably in reducing recurrence, prolonging therapeutic benefit, and improving patient prognosis. Conclusion Sole treatments and inadequate therapy are major recurrence risks. Anti-fibroblast growth strategies are crucial, barring physical interventions. Despite no established gold standard, corticosteroid and excision therapies remain critical benchmarks for evaluating new treatments.