Bioinformatics Across the Cutaneous Scar Spectrum: Molecular States, Digital Phenotypes and Clinical Translation

Cutaneous scarring spans regenerative and normal remodelling; keloid, hypertrophic, atrophic and contractile outcomes; dyspigmentation; radiation- and inherited-fragility-associated fibrosis; and rare malignant transformation. Diagnostic labels alone do not capture the molecular, cellular, spatial and clinical states that shape these outcomes. This review is the first to treat the whole cutaneous scar spectrum, rather than keloid and hypertrophic scar alone, as a single computable phenotype space, and to audit jointly the provenance of the underlying datasets and the depth of validation of the resulting models. We searched four sources (PubMed, Europe PMC, OpenAlex and Crossref) on 20 June 2026 and combined systematic searching with evidence mapping; 26,575 records were identified, 920 entered the evidence map and 120 were prioritised for synthesis. Bulk studies identify tissue-level fibrotic programmes, whereas single-cell and spatial approaches resolve fibroblast, immune, endothelial and epithelial states and niches. Evidence remains concentrated in keloid and hypertrophic scar, and often reuses public datasets or extrapolates from associated cutaneous-fibrosis systems. Atrophic scars are represented mainly by quantitative imaging and treatment studies: topography and dermal loss are measurable, but no mature molecular or spatial atlas is available and atrophic acne scars are usually excluded from molecular cohorts. Scar pigmentation lacks interoperable labels, calibrated colour measurement, melanocyte-resolved spatial resources and skin-tone-stratified assessment. Fourteen studies applied artificial intelligence directly to scar data, but only one explicitly reported independent external validation. Molecular biomarkers and treatment-response models remain at discovery or internal-validation stages. Future work should standardise multidimensional phenotypes, build prospective skin-tone-stratified cohorts across the full scar spectrum, resolve rare populations such as melanocytes, and complete causal and external validation before clinical deployment.