TGFB1 and keloid: Keloid fibroblasts not only respond to macrophage signals but also secrete TGF-β to promote M2 polarization (21), creating a pro-fibrotic feedback loop that exacerbates scarring (22).This macrophage-fibroblast crosstalk critically drives keloid progression through both direct cellular interactions and modulation of the local immune microenvironment (23).Research indicates that macrophages can attract other immune cells (such as lymphocytes and neutrophils) to the site of injury by releasing pro-inflammatory factors.