Keloids mostly occur between the ages of 10 and 30 years and grow continuously beyond the original margins of the scar. Beside the cosmetic impairment they often lead to pruritus, pain, contractures and decrease in quality of life. Advances in the understanding of the genetics and pathogenesis of hypertrophic scars and keloids have led to new therapeutic options. Nevertheless treatment remains a challenge and there is no single treatment modality which is appropriate for all types of scars. Combined approaches are becoming more widely employed as they are more effective than single treatment modalities. This article gives an overview of hypertrophic scars and keloids, their pathogenesis and recommended therapeutic approaches.