Exosomes in Hypertrophic Scars and Keloids: Mechanisms and Therapeutic Potentials—A Narrative Review

BACKGROUND: Hypertrophic scars and keloids, types of pathological scars, arise from dysregulated wound healing, marked by abnormal fibroblast activation and excessive extracellular matrix (ECM) deposition. Current treatments have high recurrence rates and side effects, necessitating targeted therapies. Exosomes, extracellular vesicles mediating intercellular communication, offer multi-target regulatory potential to address scar formation complexities. METHODS: This narrative review synthesizes in vitro and in vivo studies (2020-2025) from PubMed and Scopus on exosomes' role in regulating hypertrophic scars and keloids, proposing innovative therapeutic approaches. RESULTS: Therapeutic exosomes attenuate inflammation, promote wound healing, inhibit fibrosis, and modulate the scar microenvironment. They suppress fibroblast-to-myofibroblast transformation, regulate collagen synthesis, and inhibit fibrotic pathways, particularly via the Transforming Growth Factor-beta/Sma- and Mad-related protein (TGF-β/Smad) signaling pathway. CONCLUSION: Exosomes are a promising cell-free therapy for pathological scars due to their multi-target regulatory capabilities. Future research should optimize large-scale production, standardize protocols, and develop targeted delivery systems to enable clinical translation, with validation through clinical trials.