THE CROSS (Chemical Reconstruction of Skin Scars) technique utilises high concentrations of trichloroacetic acid (TCA) to improve the appearance of atrophic acne scars. This study aimed to compare the efficacy, safety, and tolerability of the CROSS technique using 70% and 100% TCA.
A total of 40 patients were enrolled and randomly assigned to two equal groups of 20. The first group received treatment with 70% TCA, while the second group was treated with 100% TCA. Both patient-reported outcomes and researcher assessments were used to evaluate treatment effectiveness. Additionally, the intensity of the burning sensation experienced during the procedure was measured, and the duration of the frosted appearance of treated areas was recorded.
The mean age of participants in the 70% TCA group was 27.07 ± 5.48 years, while in the 100% TCA group, it was 23.5 ± 2.9 years. Post-treatment scores provided by both patients and researchers showed no statistically significant differences between the two groups, suggesting comparable overall efficacy. However, within the 100% TCA group, treatment success varied according to scar type. Specifically, icepick scars responded significantly better to the higher concentration than boxcar scars. Furthermore, crusting duration following the procedure was significantly longer in patients treated with 100% TCA, indicating a more intense healing response.
The findings of this study suggest that both 70% and 100% TCA achieve similar overall results in the treatment of atrophic acne scars. However, 100% TCA may be particularly beneficial for patients with icepick scars, as it demonstrated superior efficacy for this scar type. Despite this advantage, prolonged crusting in the 100% TCA group may indicate a more extended recovery period, which could affect patient preference and tolerability. These results highlight the importance of individualised treatment selection based on scar morphology and patient tolerance to post-procedure healing times.
Katie Wright, EMJ
Reference
Soysal MÇ, Akçalı C. Comparison of 70% and 100% concentration of trichloroacetic acid peeling efficacy with chemical reconstruction of skin scars technique in atrophic acne scar treatment. Arch Dermatol Res. 2025;317(1):547.
