Pathological scars arise from abnormal repair of skin trauma and are associated with pain, pruritus, and cosmetic deformities, severely impairing patients' physical and mental well-being. Current clinical therapeutic strategies, including surgical excision, photodynamic therapy and pharmacotherapy, are associated with inherent limitations. In recent years, nanoparticle-based delivery systems, leveraging their advantages including small size, excellent biocompatibility, and robust targeting capability, have offered novel strategies for the prevention and treatment of pathological scars. These systems can either be used alone as functional components or serve as carriers to enable precise delivery of therapeutic agents to the epidermis or dermis. This article first introduces nanoparticles along with their classification and characteristics, then elaborates on the latest research progress of nanoparticles in the treatment and prevention of pathological scars, covering their single-agent applications and combination therapies. Finally, it discusses the potential application value of nanoparticles in achieving precise prevention and treatment of pathological scars, aiming to provide new insights for clinical translation.