The TCA CROSS Method of Treating Acne Scars: New Hope for Deep Ice-Pick Type Scarring

Due to the difficulty in treating icepick-type acne scars, there seems to be a great deal of interest in the TCA Cross procedure but relatively few sources of solid information online.

This article is based on the original research that first describes the method, "Focal Treatment of Acne Scars With Trichloroacetic Acid: Chemical Reconstruction of Skin Scars Method" by Lee, Jung Bock, et al.2002.

Researchers and doctors had known for some time that lower concentrations of trichlororacetic acid (TCA) was an excellent mild to medium chemical peel due to its ability to stimulate collagen growth; however, higher concentrations of TCA leads to scarring and skin discoloration.

Out of desire to use TCA at higher concentrations to treat deeper scars the focal TCA Cross method was born (focal means a small area). This method involves using a sharp wooden application to apply 65 to 100% TCA to the base of a scar. After about ten minutes, the scar forms a white crust signaling that the procedure is complete for that scar. Intuitively, it seems odd to apply acid to the bottom of a scar, but the purpose of the TCA is to damage and, thereby, stimulating collagen growth, effectively pushing the scar up from unde
eath.

In this original study, the researchers found that 100% was more effective than 65% TCA, as 30 of the 32 patients in the 100% group had "good" or "excellent" results based on the assessment of two physicians who didn't know which patients were in each group. Some patients had 5 or 6 treatments spaced 1 to 3 months apart. All the patient in the 100% group who had 5 or 6 treatments showed "excellent" results.

The authors claim to have had success using the TCA Cross technique on other types of scars like boxcar and rolling; however, all the research I've read only recommends this method for icepick scars.

Icepick scars seem to be the most difficult to treat because they're resistant to any sort of resurfacing technique like the older chemical peels and dermabrasion and the newer laser resurfacing. As opposed to rolling and many boxcar scars that can be improved, resurfacing procedures just can't penetrate deep enough to improve the appearance of icepick scars. In order to improve icepick scars, punch excision or TCA Cross will probably be necessary.

Punch excision is good technique; however, it involves more discomfort and can't be used to treat adjacent scars because the healing process causes the skin to tighten. The authors of the study claimed that no anesthesia was needed during the TCA Cross procedure and list no warnings about simultaneously treating multiple scars that are close together.

Unfortunately, based on reading multiple forum posts by real scar sufferers, it seems like few dermatologist are familiar with TCA Cross, so you'll probably have to search around. However, time search is time very well spent. Success depends on finding the right dermatologist or cosmetic surgeon who specializes in acne scars. For example, if I were seeking acne scar treatment, I would expect to be on a waiting list for several months and to travel out of state to a major city for a procedure.