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Pathological skin scarring, including hypertrophic scars and keloids, arises from dysregulated wound healing processes involving excessive inflammation and mechanical tension, leading to fibroblast differentiation and disorganized collagen deposition. The review identifies key signaling pathways, such as TGF-β/Smad and TNF-α/NF-κB, as therapeutic targets and highlights a novel treatment using atorvastatin delivered via a keratin hydrogel derived from human hair. This approach offers a sustainable, localized anti-fibrotic therapy. Combination therapies are suggested to be more effective than monotherapies, although recurrence remains a challenge. The document also discusses genetic predispositions, various current treatments, and emphasizes the need for further research to optimize therapies for scar-free healing.