Keloid scars are defined as a scarring abnormality resulting from excessive proliferation of myofibroblasts and increased collagen deposition within the scar. The treatment of keloids is highly sought after in dermatological consultations, and the therapeutic strategies described are not effective in all patients; it is noteworthy that the auricular pavilion is one of the most common sites for keloid recurrence. Keloid scars originate from a disordered and fibroproliferative collagen response due to excessive production of the extracellular matrix. Surgical excision proves ineffective in many cases, with recurrence rates varying between 45% and 100% according to various studies. However, when this intervention is combined with other therapies, substantial improvement in outcomes is evident. The use of methotrexate has been described in the treatment of keloids, as it not only suppresses the expression of type I collagen but also increases the expression levels of metalloproteinases in primary fibroblasts of hypertrophic scars, thereby making it an innovative therapeutic option.