Background: Keloids are disfiguring fibrous scars distressing patients emotionally. Keloids are yet considered as a challenge for doctors to treat due to their high ability of regrowth and extending. Prevention of keloid scar is considered as the first line of keloid management. Many theories were suggested to explain keloid formation. Imbalance between synthesis and degradation of collagen and extracellular matrix is the most realistic theory. Keloid scar assessment has been done clinically for years, though it hasn't shown all the aspects of scar. So, radiological assessment has been tried for a couple of years and proved to be efficient in keloid scar assessment combined to clinical assessment. Many treatments were tried in keloid therapy, where intra-lesional corticosteroids injection was stated as the first line treatment, later on other therapies as lasers, compression, cryosurgery, occlusive therapy, 5-fluorouracil, interferon, retinoid acids, vitamin D, surgical excision and radiation were tried either as a monotherapy or combined. Objective: Detecting developments in the formation and treatment of keloids in order to help the doctor choose the optimal method of treatment according to each patient after its adequate clinical evaluation and by Doppler. Conclusion: Keloids are a psychological burden for the patient and a challenge for doctors in treating it. Every day, new theories are being discovered about the formation and physiology of keloids, which helps to discover effective treatments. There is no specific method for evaluating keloids, so clinical scales are best used in conjunction with imaging. There is no specific treatment agreed upon, but the combined treatments have proven to be more effective than using each treatment alone.