TCA Cross treatment aims to improve the appearance of atrophic acne scars. During the procedure, small amounts of TCA, at very high concentrations is applied to the base of the atrophic scar. This causes an inflammatory reaction which in turn lead to the increase in collagen formation which helps to decrease the scar depression.


When Is TCA CROSS Used?

TCA CROSS is most useful in the treatment of the following types of atrophic scar:

• Boxcar acne scars
• Rolling acne scars
• Ice-pick acne scars

The TCA CROSS Procedure

• The treatment is usually preceded by 2 weeks of a prescribed cream and followed by 4 weeks of using the same cream.
• A local anaesthetic is applied 30 min prior to the treatment.
• The patient lies down in a comfortable position depending on the area to be treated.
• The skin is cleansed.
• At this point, the treating professional may perform an additional procedure to enhance the effect of the TCA CROSS procedure.
• A fine instrument is used to apply TCA to the base of the atrophic scar (s).
• The instrument is removed at the start of frosting (the skin appearing white) of the skin surface (usually within 10 seconds).
• The skin is intermittently cleansed.

After the procedure

Most patients require 3 to 6 treatments with TCA CROSS for optimum improvement. Treatments may be repeated at 2 to 8-week intervals over 6 months. General information:

• Frosting of the scar surface may last up to 12 hours.
• The skin around the treated sites may be red and sore for 24 to 48 hours.
• After 2 to 3 days a small scab will develop, which falls off after 3 to 7 days.
• He or she may wash as normal and may apply make-up if desired.
• Sunscreen is mandatory to reduce the chance of pigmentation.
• Apply prescription cream for 4 weeks after the procedure.
• Response to treatment will be monitored at recommended intervals.

Complications of TCA CROSS

TCA CROSS is generally well tolerated. Complications are rare when treatment is undertaken by an expert.
They may include:

• Prolonged local irritation and erythema.
• Damage to mucosal surfaces, ie lip, nostril, conjunctiva or cornea (eye) leading to painful ulceration and potential scarring, if TCA is inadvertently deposited on these sites.
• Post-inflammatory hyperpigmentation (usually transient) or hypopigmentation (maybe permanent).
• Coalescence of adjacent scars to form larger scars.
• Sub-optimal response or lack of improvement in scarring.

Treatments that can be used with CROSS TCA to enhance effect

These treatments will be discussed separately.

• Topical retinoids
• Microneedling — Dermaroller, Dermapen
• Subcision