Advances in the interplay between mechanical forces and inflammatory immunity in keloid formation

Keloids are chronic inflammatory fibroproliferative disorders characterized by invasive growth beyond the original wound margins and a high recurrence rate, substantially impairing patients' quality of life. Their pathogenesis is complex and arises from the synergistic interplay among the mechanical microenvironment, chronic inflammation, and profibrotic signaling networks. The inflammatory and proliferative phases of normal wound healing are pathologically prolonged, with sustained activation of fibroblasts and myofibroblasts, resulting in excessive extracellular matrix (ECM) deposition and aberrant remodeling. Within the immune microenvironment, infiltrating M2 macrophages and Th2/Th17 cells, among others, secrete a broad array of cytokines, thereby establishing a chronic inflammatory circuit. Mechanical forces act as a pivotal driving factor: stress concentration in high-tension regions and activation of fibroblast mechanotransduction pathways (e.g., Hippo-YAP/TAZ and integrin-FAK) interact with inflammatory responses to form a self-amplifying "mechanical force-inflammation-fibrosis" positive feedback loop, exacerbating disease progression. Current management primarily relies on multimodal regimens such as surgery combined with radiotherapy and intralesional pharmacologic injections, yet remains challenged by high recurrence rates and marked heterogeneity. In recent years, tension-reduction approaches grounded in mechanomodulation and targeted therapies against inflammatory pathways such as JAK/STAT and IL-4/IL-13 have shown progress, and integrated "mechanics-inflammation" combinatorial interventions are emerging as a new direction. The review summarizes the pathophysiological features of keloids and elucidates the roles and crosstalk of mechanical forces and inflammation, thereby providing a novel theoretical framework centered on mechano-immunology for future individualized clinical management of keloids.