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Keloid scars first appeared on literature more than 5000 years ago. Pathological scars can affect the quality of life and cause functional problem. Studies have been done to understand the underlying the pathology. Various treatment
modalities have been used to treat pathological scars. Different theories including mechanical, endocrinological, genetic and metabolic have been described. Treatment modalities range from topical agent to intralesional injection, laser, surgery and radiotherapy. The mechanism and morbidities of the treatment options will be described. Recent advances and potential treatment will be discussed.