Acne scars come in a variety of forms, each of which responds best to one or more of a range of treatments which includes lasers, skin rolling, dermal fillers, TCA Cross, subcision and surgery. The anatomy of your scars will determine which treatment or combination of treatments will achieve the best result.
TCA Cross stands for Trichloracetic Acid (TCA) Chemical Reconstruction of Skin Scars (CROSS).
TCA has been used for decades as a skin rejuvenation treatment and has proven safe and effective both as a light (12.5%) or mid-depth (20-30%) peel.
An article published by Dr Jung Bock Lee in Korea in 2001 drew attention to its application at much higher concentrations for the treatment of pitted, or ice pick, acne scarring.
Dr Lee studied 64 patients with acne scarring, 32 of which were treated with 65% TCA and 32 with 100% TCA. All reported significant improvement in their scarring, with no downtime and no complications. Results achieved were slightly better at the higher concentration, with no increase in side effects. TCA induces new collagen and elastin production that helps to lift the scar and normalise skin texture. Healing is rapid and complications are rare because treatment is focused on individual scars whilst leaving adjacent healthy skin untreated.
What does TCA Cross involve?
After washing your face with soap, the skin is cleansed with alcohol 100% TCA is then applied deeply into the acne scar for about 10 seconds using the tip of a toothpick until a white frosting appears on the skin. The procedure is tolerable, with most patients reporting only mild and temporary stinging as the TCA works on the scars. Local anaesthetic or sedation is not required.
The ‘frosted’ appearance resolves over a few minutes and the skin becomes red. Small scabs form over a few days and these naturally fall off after about 7 days. Darker skinned patients may notice some temporary darkening around the treated areas. Daily application of a broad spectrum SPF 30+ sunscreen will minimize this risk.
Multiple sessions are required for the best results, and these are spaced at least one month apart. Most patients begin to see improvements within 1-3 sessions, though the final result is usually only seen after many months, even up to 12 months, as induced collagen production is slow and ongoing.
An emollient ointment such as Vaseline should be applied regularly to the healing wounds for approximately one week, or until the scabs flake off. It is important not to disturb the scabs during this healing phase. The longer the scabs stay on the better. Dressings are not required. Once all the scabs have fallen off, you may wash your face with a gentle cleanser, resume your normal skin care routine and apply makeup if necessary. SPF 30+ sunscreen should be worn on a daily basis.
Are there any risks?
As with any procedure that penetrates the skin, TCA Cross involves the potential risk of temporary pain, bruising, swelling, itching, scabbing, lumpiness, persistent redness, infection, permanent colour changes in the skin, either darker or lighter, scarring including keloid scarring, poor cosmetic outcome or ineffectiveness of the treatment on your selected problem area, or activation of pre-existing cold sore infection.
Am I a suitable candidate for TCA Cross?
You may not be a suitable candidate for TCA Cross if you have taken Roaccutane for cystic acne within the last 6-12 months, have active cold sores, acne, dermatitis or psoriasis in the area to be treated, heal poorly or are prone to keloid scarring. Smokers should be aware that smoking compromises the body’s ability to grow new collagen.
Alternative treatments for ice pick acne scarring
Isolated ice pick scars may be suitable for punch excision. Very superficial shallow scars may be suitable for fractional laser resurfacing or dermal filling.