Deciphering the cellular landscape of pathological scars

Pathological scars (PSs) are characterized by excess dermal collagen deposition and primarily manifest as hypertrophic scars and keloids. The microenvironment of PSs is shaped by a diverse array of cells, collectively forming a profibrotic and proangiogenic niche. Recent advances in high-throughput sequencing have enhanced our understanding of the cellular heterogeneity, transcriptional changes, and intercellular communication within the PS microenvironment. This review comprehensively describes the cellular landscape of PSs, including mesenchymal cells, endothelial cells, epithelial cells, and immune cells. Additionally, we evaluate precision medicine strategies ranging from biomarker-driven diagnostics to targeted biological therapies and innovative drug delivery systems. We aim to provide a mechanistic framework that accelerates the translation of basic experimental research into effective and personalized treatments for pathological scarring.