Interpreting Autophagy-Lysosome Evidence in Hypertrophic Scars and Keloids: A Narrative Review

The therapeutic relevance of autophagy-lysosome findings in hypertrophic scars (HTS) and keloids remains uncertain. We appraised 78 mechanistic claims across 62 reports in a disease-stratified narrative review, distinguishing static markers from dynamic process measurements and causal evidence. Basal autophagic flux across untreated HTS lesion stages remained unresolved. Findings in keloids indicated context-specific differences in turnover, maturation or clearance, and lysosomal distribution, without establishing a uniform lesion-wide state. Treatment studies reported cellular and scar responses but seldom established mediation by autophagy. These findings do not support indiscriminate therapeutic activation or inhibition of autophagy. PubMed-centered coverage, incomplete retrieval records, access constraints and uneven appraisal depth limit interpretation. Failure to establish a mechanism does not show that it is absent from scar biology. Clinical translation requires disease-, stage- and process-matched testing, intervention after lesion establishment for treatment claims, meaningful scar outcomes, assessment of repair safety and follow-up after treatment withdrawal.