The management of keloid and hypertrophic scars is commonplace in all burns and plastic surgery outpatient clinics, and in this paper the authors review many of the current treatments available for this difficult problem. They start with an introduction about the background of wound healing, the aetiology and risk factors for the formation of different scars and also describe the differences between keloids and hypertrophic scars at a cellular level. They then proceed to outline the different treatment modalities, both classical and those currently being trialled, reviewing the strength of evidence for the efficacy, mechanism of action, as well as the pros and cons of each. They include such treatments as massage therapy, compression garments, tapes and silicone gels, intralesional corticosteroid injection and the use of different lasers, cryotherapy, radiotherapy, 5-fluorouracil, interferon, botulinum toxin A, and several others including surgery. They conclude with a table of ‘updated recommendations’ for the prevention and treatment of these scars and advise a triple therapy approach of steroid, 5-fluorouracil and pulse dye laser, although they admit that further well designed trials are required to fully evaluate the most effective treatment. This article will be very useful both to trainees sitting exams, as well as consultants who are regularly faced with patients suffering from this challenging, and common complication of burn surgery.