Fibrosis-associated non-coding RNAs in keloids: Dual roles in pathogenesis and therapy: A review

Keloids are characterized by fibroblast overproliferation and dysregulated extracellular matrix (ECM) deposition. They often cause itching, pain, and cosmetic problems that severely diminish patients' quality of life. Despite available treatments such as surgical excision, laser therapy, cryotherapy, and pharmacologic interventions, high recurrence rates remain a major clinical challenge. Consequently, there is an urgent need to develop more effective therapeutic strategies. In recent years, increasing evidence has demonstrated that non-coding RNAs (ncRNAs) possess dual regulatory roles in the fibrotic process of keloids. Fibrosis-associated ncRNAs modulate molecular mechanisms underlying fibroblast functions and microenvironment remodeling. Their high stability, tissue-specific expression, and functional diversity make them promising biomarkers and therapeutic targets. In this review, we summarize research from the past five years on ncRNAs in keloid fibrosis, with a focus on their dual regulatory roles and underlying mechanisms. In addition, we explored the potential value of exosome-derived ncRNAs (Exos-ncRNAs) in influencing fibroblast function by regulating intercellular communication. Finally, we also characterized the clinical significance of these ncRNAs, including as biomarkers/therapeutic targets and the association of clinical drugs with ncRNAs. In summary, this study provides a more in-depth exploration of the molecular mechanisms of ncRNAs in keloid fibrosis formation and offers new insights for the development of biomarkers/targeted therapies.