Abstract: The recurrence of keloid remains a core challenge in treatment, with high recurrence rates following simple surgical excision. Recent research has proposed the “epigenetic memory” hypothesis, suggesting that even after primary lesion removal, the surrounding microenvironment can reactivate quiescent stem cells, leading to a restart of the fibrotic process. This review systematically summarizes recent evidence on factors influencing keloid recurrence, including host intrinsic factors, disease-related factors, treatment-related variables, and molecular mechanisms, and evaluates the evidence base for existing prevention strategies.

Key words: keloid, recurrence, influence factor