Chemical Reconstruction Of Skin Scars Research Articles

Comparing the Use of 80% Trichloroacetic Acid and 50% Trichloroacetic Acid for the Treatment of Ice Pick Acne Scars

BACKGROUND Chemical reconstruction of skin scars (CROSS) using high concentration trichloroacetic acid (TCA) is a safe, effective, and low-cost treatment for ice pick acne scars. OBJECTIVE To compare the efficacy and effectiveness of the CROSS technique using 50% TCA and 80% TCA for treating ice pick scars. MATERIALS AND METHODS A nonrandomized, single-blinded, and self-controlled clinical trial was undertaken. Four CROSS sessions were conducted using 50% TCA on the left hemiface and 80% TCA on the right hemiface. The E′ chelle d'Evaluation Clinique des Cicatrices d'Acne (ECCA) acne grading scale was used to assess the scars pretreatment and posttreatment. Complications were evaluated after each session. RESULTS Thirty-one patients participated in our study. Significant differences were found between pretreatment and posttreatment ECCA scores (p < .0001) on both hemifaces. Scores were significantly lower on the side treated with 80% TCA; however, there was no statistical significance in mean ECCA score differences (pretreatment minus posttreatment) between the 2 treatment sides. The adverse events were more serious on the sides treated with 80% TCA. CONCLUSION The CROSS method using TCA was well-tolerated and effective for treating ice pick acne scars. Less severe complications were associated with 50% TCA, whereas efficacy was the same as 80% TCA.

Combination Procedure for Acne Scars Revision, Is It Needed?

Background: The treatment of acne scars is a problem for dermatologist. Varied morphology of acne scars makes the treatment more difficult. Combination technique has high efficacy than monotherapy. The challenge is how to select best combination procedure for scar revision.
 Case presentation: A 43-year-old male present with acne scars since 5 years ago. Dermatological findings revealed atrophic acne scars (ice pick, boxcar, rolling) types on forehead, nose and cheeks. Diagnosis established as moderate atrophic acne scars with global acne scarring system (GASS) is 21. Patient treated with blunt canula subcision, hyaluronic acid (HA) filler, microneedling radiofrequency, 90% trichloroacetic acid chemical reconstruction of skin scars (TCA CROSS) and application of salmon polydeoxyribonucleotide (PDRN). Patient also received topical 0.05% retinoic acid, 4% niacinamide, and sunscreen for daily. After 10 days, there is flattening and disappear of ice pick and boxcar, elevating of rolling scar, GASS score is 15. Blunt cannula subcision and HA filler is safe, effective for rolling scar through fibrous band breaking and prevent re-adhesion. Microneedling RF is effective for boxcar, otherwise 90% TCA CROSS preferrable for ice pick scars. This combination procedure leading cellular necrosis in epidermis, collagen in dermis, and stimulate regeneration. Application of Salmon PDRN may promote wound healing, hydrate the epidermis, and prevent dyschromia.
 Conclusion: Combination of subcision, dermal filler, microneedling radiofrequency, 90% TCA CROSS, and Salmon PDRN has high efficacy for scar revision through collagen remodelling and acceleration wound healing.

Combined use of CROSS TCA and modified subcision with PRP administration for acne scars

Background: Acne vulgaris is a skin disease that can cause permanent scarring. Various therapeutic options are available to treat atrophic scars, but combination therapy is still the best choice according to different types of scars in a single patient. Chemical reconstruction of skin scars (CROSS) trichloroacetic acid (TCA), modified subcutaneous incisionless (subcision), and platelet-rich plasma (PRP) can be used as a combination therapy to treat acne scars. Case Illustration: A 25-year-old man complained of acne scars on both sides of his face. Dermatologic findings were blackheads, icepick, boxcar, and rolling scars. Clinically he had moderate to severe acne scores. He was treated with a combination of CROSS TCA for icepick-type acne scars, modified subcision, and PRP injection for rolling and boxcar-type acne scars on both sides of the face. During treatment, the patient was given oral and topical antibiotics. The patient was followed-up after one month. It resulted in a good therapeutic response, which showed 25%-49% of Goodman and Baron’s classification, and a visual analog scale of 6. Discussion: CROSS TCA is a therapeutic choice for icepick-type acne scars with a simple, practical technique and provides a significant effect. Modified subcision is modified therapies from the previous Khunger subcision technique and a new alternative that can be applied to damaged tissue. This can maximally repair scarring, facilitate surgeon, provide avenues, and increase maximum PRP penetration. Conclusion: CROSS TCA with subcision and PRP are simple procedures that can be applied as an alternative therapy to acne scars with good therapeutic response. Keywords: CROSS TCA, PRP, scars, subcision

“A Comparative Analysis of Microneedling and TCA CROSS For Management of Atrophic Acne Scars”

Title -“A comparative analysis of microneedling and TCA CROSS for management of atrophic acne scars” Background: Acne is a disorder of pilosebaceous unit which can lead to scarring, commonly seen on face. It is emotionally and psychologically distressing to the patients. Both microneedling and TCA CROSS are commonly used office procedures to treat acne scars and both work on principle of collagen remodelling. While microneedling and TCA cross is widely being performed on Indian skin for various indications, there is a paucity of published literature comparing the safety and effectiveness of these two techniques specifically for acne scars in Indian patients. Objective: To compare the safety and effectiveness of microneedling and TCA CROSS (trichloroacetic acid chemical reconstruction of skin scars) in atrophic acne scar in Indian subjects. Materials and method: Fifty participants were randomly divided using closed envelope method in two equal groups of 25 patients each; group A underwent three sessions of microneedling (at 4 week interval) and group B underwent three sessions of TCA CROSS (at 4 week interval). Results: On quantitative assessment there was a constant per cent decrease in mean acne scar score (Goodman and baron) in both the groups but the decrease in group B was more as compared to group A. On qualitative assessment group B was found to be better than group A. However, subjective satisfaction in group A patients was more compared to group B. Conclusions: Microneedling and TCA CROSS were safe and effective in treatment of acne scars.

Painting CROSS TCA technique: Modification of the CROSS method for the treatment of atrophic acne scars-Case series.

The Chemical Reconstruction of Skin Scars (CROSS) technique was first described in 2002 and has since demonstrated safety and efficacy in multiple studies. We describe the treatment of six patients with a modified version of the CROSS method-the Painting CROSS trichloroacetic acid (TCA) technique. This technique has the advantage of offering even higher tissue selectivity and better control of the scar edges, enhancing both safety and efficacy. We retrospectively evaluated 31scars of six patients who underwent a single treatment by the Painting CROSS TCA method. A 0.3ml insulin syringe with a 30-gauge needle was filled with 0.05ml of 85% TCA solution and then applied to the scar base with slight pressure until frosting was achieved. Patients were evaluated before and 3months after treatment for scar volume deficit by a high-resolution three-dimensional imaging system. The average volume of the 31scars assessed in our study was 2.71mm3 before treatment and 1.96mm3 after treatment. There was a 26.3% average decrease in the volume of the scars after one treatment. Transient mild hyperpigmentation was noted in two patients after the treatment. Painting CROSS TCA technique has demonstrated efficacy in the treatment of acne scars after a single treatment.

Combined subcision, autologous platelet-rich plasma, and CROSS technique in the treatment of atrophic acne scars: Prospective split face study.

Acne scars represent a therapeutic dilemma. This study aimed to evaluate the efficacy of combined subcision, autologous platelet-rich plasma (PRP), and chemical reconstruction of skin scars (CROSS) technique in the treatment of acne scars. In 20 patients with atrophic acne scars, one facial side was treated with subcision plus PRP, and the other was treated with the same combination plus CROSS technique (trichloroacetic acid 50%) for 3 sessions at 3-week intervals. Clinical evaluation, digital photography, quantitative global scarring grading system, and Lipper and Perez score were done at baseline, every session, and 1 month after the last session. Participants assessed their improvement at the end of the follow-up period using a scale (0 to 10). There was a significant reduction in quantitative global scarring grading system (P < .001) and Lipper and Perez score (P < .001) after treatment compared with baseline in both sides. No significant difference was found when the two treated sides were compared after treatment by both scores. Patients’ satisfaction was excellent (12 patients [60%]) and good (eight patients [40%]) with no significant difference between both sides. In conclusion, combined subcision and PRP is recommended for acne scars. Adding CROSS technique (trichloroacetic acid 50%) did not further ameliorate the condition.

Use of 27-gauge Tuberculin Syringe for Trichloroacetic Acid Chemical Reconstruction of Skin Scars (TCA-CROSS).

Chemical Reconstruction of Skin Scars (CROSS) is a minimally invasive, safe, and cost effective technique for the management of ice pick acne scars that are otherwise generally resistant to treatment. 100% trichloro acetic acid (TCA) is usually applied using toothpicks and the end point is white discoloration of skin. The concentrated caustic agent quite often spills onto surrounding normal skin leading to superficial burns and post-inflammatory pigmentation. Use of 27-gauge tuberculin syringe gives a much more controlled access to apply TCA leading to better cosmetic outcome and fewer adverse effects.

Chemical reconstruction of skin scars (CROSS) method for atrophic scars: A comprehensive review.

Chemical reconstruction of skin scars (CROSS) applies a high strength acid focally to treat atrophic scars. Although this method has gained popularity over the past two decades, no standardized treatment guideline exists for CROSS method in the treatment of atrophic scars. The purpose of this comprehensive review was to evaluate the indications, detailed techniques, efficacy, and safety of CROSS method. An extensive literature review was conducted to identify articles relating to CROSS method for atrophic scars from 2002 to 2018. The literature search yielded 19 articles meeting criteria. CROSS method has been used for the treatment of acne scars, varicella scars, enlarged pores, and depressed surgical scars. In studies using the quantile grading scale for acne scars, 60%-100% of patients showed >25% improvement. In two studies for varicella scars, 83%-100% of patients showed >25% improvement. CROSS method seems to be effective specifically for ice-pick scars. It is well tolerated and safe in Fitzpatrick skin phototypes I-V. Most reported complications are temporary and include postinflammatory dyspigmentation, erythema, pain, pruritus, infection, and widening of scars. This literature review suggests that CROSS method is a safe and effective treatment for atrophic scars, especially ice-pick scars, in skin types I-V. However, current published works have several limitations, including small sample sizes, lack of control group, different concentrations of acid, different frequency of treatments, and follow-up periods. Larger, randomized, controlled studies are needed to elucidate the optimal treatment protocol of CROSS method.

Treatment of atrophic acne scars with combination therapy of chemical reconstruction of skin scars method and fractionated nonablative laser: A retrospective analysis.

Patients with acne scarring often have several types of acne scars, and combination therapies have demonstrated superior success to single treatment modalities. Chemical reconstruction of skin scars (CROSS) has gained popularity as the treatment for ice-pick scars and fractionated laser therapy for rolling and boxcar scars. However, no study has looked at combination therapy with CROSS and fractionated nonablative laser for the treatment of atrophic acne scars. We sought to evaluate the efficacy and safety of combination therapy with CROSS and fractionated nonablative laser for atrophic acne scars. We conducted a retrospective analysis of patients treated with CROSS followed by fractionated nonablative laser treatment in the same visit for acne scars from 2016 to 2020. Treatment efficacy, defined as the percentage improvement in the appearance of acne scars, was assessed using a 5-point scale: score 0 (worsening or 0% improvement), 1 (1% - 25%), 2 (26% - 50%), 3 (51%-75%), and 4 (76%-100%). Twenty-five patients (14 females and 11 males, Fitzpatrick Skin Type II -V) were enrolled. The average improvement score was 2.07 after 3 sessions and 2.78 after 5 sessions. All subjects reported satisfaction, while 24% were very satisfied. There were no permanent adverse effects, and only one patient developed a temporary hypertrophic scar. We concluded that combination therapy with CROSS and fractionated nonablative laser in the same visit is an effective and safe treatment option for atrophic acne scars in patients with various skin types, including skin of color.

Use of blunted needle of insulin syringe as a simple method for precise delivery of drug during chemical reconstruction of skin scars (CROSS)

Use of blunted needle of insulin syringe as a simple method for precise delivery of drug during chemical reconstruction of skin scars (CROSS)

Combined treatment modalities in atrophic acne scars: a prospective study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Atrophic acne scars are one of the sequalae that follows acne vulgaris. These scars are big cosmetic concern presenting with varied morphology like ice-pick, rolling and boxcar scars and it needs multimodal approach to treat effectively rather than a single modality. Our main aim is to study the efficacy of combination therapy using subcision, micro-needling and trichloro acetic acid chemical reconstruction of skin scars (TCA CROSS) in a sequential manner for the management of atrophic acne scars.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Total 30 patients of either sex with grade 2, 3, and 4 atrophic acne scars were graded using Goodman and Baron qualitative grading and were enrolled in the study. After single sitting of subcision, micro-needling and 50% TCA CROSS were performed alternatively at 3 weeks interval for a total of 3 sessions of each. Grading of acne scars were done by taking photographs at pre-treatment, post treatment, 1st and 3rd month after last treatment session.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Out of 14 patients with grade 4 acne scars, 9 (64.3%) patients improved to grade 2 and 5 (35.7%) patients improved to Grade 3. Out of 10 patients with Grade 3 scars, 6 (60%) patients improved to grade 1, and 4 (40%) patients were improved to grade 2 at the end of study. All 5 patients with Grade 2 scars showed significant improvement from baseline.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Subcision, micro-needling and TCA CROSS, if they are combined and adequately done in proper manner will have excellent response in all types of atrophic acne scars.&lt;/p&gt;

MICRONEEDLING AND GLYCOLIC ACID PEEL FOR TREATMENT OF ACNE SCAR; COMPARATIVE STUDY

ABSTRACT Background : Atrophic acne scars are common and undesirable outcome of acne vulgaris related to both its severity and delay in treatment. Such scars can be classified according to the depth and shape of the collagen loss: ice pick, boxcar, or rolling. Many options are available for treatment of acne scars such as: laser surgery, radiofrequency intervention, chemical peels, chemical reconstruction of skin scars (cross technique), dermabrasion, needling, subcision, punch techniques, fat transplantation, and other tissue augmenting agents. Objective : The aim of this study was to compare between GA peel monotherapy and microneedling with dermapen monotherapy in treatment of acne scars. Moreover, combined treatment of GA peel and microneedling with dermapen is compared to each of the above monotherapies in treatment of acne scars. Methods : Thirty patients of both sexes (10 men and 20 women) with age ranged from 19-45 years old with different types of atrophic acne scars were enrolled in the study. Patients were randomly divided into three groups: Group I : Included ten patients (4 males and 6 females) aged 27 - 45 years. They had microneedling with dermapen for treatment of the scars. Group II: Included ten patients (4 males and 6 females) aged 19- 42 years. They had glycolic acid 35% peel for treatment of the scars. Group III: Included ten patients (2 males and 8 females) aged 19-39 years. They were treated with skin microneedling with dermapen combined with glycolic acid 35% peel. Results : Results revealed that there was statistical significant decrease between acne scar grade in dermapen group before and after treatment with degree of improvement (80%). Also, in glycolic acid group before and after treatment with degree of improvement (70%). Statistical significant decrease between acne scar grade in combination group before and after treatment with degree of improvement (100%). Statistical significant increase in frequency of improvement in rolling compared to boxcar and icepick in all groups and also in boxcar compared to icepick. Conclusion : Dermapen and glycolic acid peel are effective and safe techniques in acne scars especially (superficial scars). Combination of dermapen and glycolic acid peel is more effective than monotherapy by either dermapen or glycolic acid peel and also helps in improvement of deep acne scars. Keyword : Microneedling, Glycolic acid, Acne scar.

Microneedling vs. chemical reconstructon of skin scars with trichloroacetic acid: a comparative study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Acne scars are a cause of major psychological morbidity in the young population. Microneedling using dermarollers which uses the principle of percutaneous collagen induction and Chemical reconstruction of skin scars (CROSS) using Trichloroacetic acid (TCA) are both widely used methods for the treatment of acne scars and are cheaper alternatives to LASER resurfacing. The aim of our study is to objectively compare the efficacy of microneedling using dermaroller with CROSS using 100% TCA in the management of acne scars.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 30 patients with acne scars were divided into 2 groups A and B with 15 patients each. Group ‘A’ underwent microneedling using 1.5 mm dermaroller and Group ‘B’ underwent CROSS technique with 100% TCA. A total of 4 sessions at monthly intervals were performed on both groups. The percentage improvement in the acne scar grade between the two groups was compared using the student ‘t’ test.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Among the 30 patients, 13 (86%) patients in Group A (Microneedling) and 11 (78%) patients in group B (CROSS) noted significant reduction in their acne scar grade. The difference between the 2 groups was statistically insignificant. 3 patients had significant post inflammatory hyperpigmentation in group ‘B’.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The techniques of microneedling and CROSS are both effective in acne scars But microneedling scores in other aspects such as faster wound healing, better skin rejuvenation and safety in dark skinned individuals.&lt;/p&gt;

Subcision plus 50% trichloroacetic acid chemical reconstruction of skin scars in the management of atrophic acne scars: A cost-effective therapy

Subcision plus 50% trichloroacetic acid chemical reconstruction of skin scars in the management of atrophic acne scars: A cost-effective therapy

Randomized clinical trial of CO2 LASER pinpoint irradiation technique versus chemical reconstruction of skin scars (CROSS) in treating ice pick acne scars

Background: Pinpoint irradiation technique CO2 LASER and Chemical Reconstruction Of Skin Scars (CROSS) are effective treatments for atrophic acne scars as fractional photothermolysis. Objective: This study was designed to prospectively compare the use of a pinpoint irradiation technique versus TCA CROSS in treating ice pick acne scars. Methods: Thirty-two patients with ice pick acne scars were included in this open, label pilot study. Pinpoint irradiation technique by CO2 LASER and TCA CROSS were applied for the study and control group, respectively. Twenty-eight patients with ice pick acne scars were included in this open, label pilot study. They were randomly assigned to two groups: the first group (14 patients) received pinpoint irradiation by CO2 LASER as a study group, and the second group (14 patients) received TCA CROSS as a control group. In both treatments, there were four sessions at 3-week interval, and 3 months of follow up. Results: There were statistically significant difference in acne scar severity index and qualitative scarring grading system in the improvement results between the study and control groups (p < 0.05). Conclusion: Pinpoint irradiation technique by CO2 LASER is safe and more effective than TCA CROSS technique. Clinical improvement was achieved in all 14 patients without dramatic adverse effects.

Chemical reconstruction of skin scars (CROSS) technique using trichloroacetic acid 50% in different types of atrophic acne scars

Introduction Acne scarring is a common complication of acne, and no appropriate and effective single treatment modality has been developed yet. A new technique of focal application of high strength trichloroacetic acid (TCA) (65-100%) has been suggested. The aim of the study was to evaluate the efficacy and safety of 50% TCA in three different types of atrophic acne scars using the chemical reconstruction of skin scars technique in three sessions, each at an interval of 1 month. Materials and methods Thirty adults with a clinical diagnosis of atrophic acne scars were selected. Results Statistically significant difference was found in the total Goodman score between the atrophic acne scars before and after treatment ( P P P Conclusion Chemical reconstruction of skin scars technique using 50% TCA is nonsurgical and safe in the treatment of atrophic acne scars, especially the icepick type followed by the boxcar scars, with minimal side effects and a short downtime.

Chemical reconstruction of skin scars therapy using 100% trichloroacetic acid in the treatment of atrophic facial post varicella scars: A pilot study

Context:Chickenpox (varicella) is a common viral disease caused by Varicella zoster virus. Facial atrophic scars after varicella infection are not uncommon and pose a cosmetic problem. Like atrophic scars of other aetiologies, they are a difficult condition to treat. There are not enough references in the literature regarding efficient treatment of post varicella scars. High strength Trichloroacetic acid (TCA), which is known to cause dermal collagen remodelling, was used to treat varicella scars in the present study.Aims:The study was undertaken to assess the efficiency of Chemical Reconstruction of Skin Scars (CROSS) technique using 100% TCA in the treatment of atrophic facial post varicella scars. Settings and Design: Open label, pilot study.Materials and Methods:A total of 16 patients with atrophic facial post varicella scars were treated by focal application of 100% TCA solution by pressing down upon the scar surface by a toothpick (CROSS technique). Total 4 sittings were given at 2 weekly intervals and the results evaluated after 3 months of follow-up. Statistical analysis was carried out using Fischer's exact t-test.Results:All of the 13 patients who completed the study showed good clinical improvement, with 69% patients grading the response as excellent (>75%) improvement, whereas the rest 31% patients reporting good (51-75%) improvement. No significant complications were seen in any patient.Conclusions:CROSS technique using 100% TCA is a safe, cheap and effective therapy for the treatment of post varicella scars.

Treatment of atrophic acne scars with 1046 nm Nd

BackgroundVarious modalities had been tried for treatment of acne scars. Both 1064 nm Nd:YAG laser and chemical reconstruction of skin scars (CROSS) using high trichloroacetic acid (TCA) concentrations have been used in the treatment of atrophic acne scars and depressed wrinkles.ObjectiveTo compare

Subcision Versus 100% Trichloroacetic Acid in the Treatment of Rolling Acne Scars

Acne scarring is common but surprisingly difficult to treat. Newer techniques and modifications to older ones may make this refractory problem more manageable. The 100% trichloroacetic acid (TCA) chemical reconstruction of skin scars (CROSS) method is a safe and effective single modality for the treatment of atrophic acne scars, whereas subcision appears to be a safe technique that provides significant improvement for rolling acne scars. To compare the effect of the 100% TCA CROSS method with subcision in treating rolling acne scars. Twenty patients of skin types III and IV with bilateral rolling acne scars received one to three sessions of the 100% TCA CROSS technique for scars on the left side of the face and subcision for scars on the right side. The mean decrease in size and depth of scars was significantly greater for the subcision side than the 100% TCA CROSS (p<.001). More side effects in the form of pigmentary alteration were observed with the 100% TCA CROSS method. For rolling acne scars in patients with Fitzpatrick skin types III and IV, subcision shows better results with fewer side effects than the 100% TCA CROSS technique, although further decrease in scar depth with time occurs more significantly after 100% TCA CROSS.

Evaluation of CROSS technique with 100% TCA in the management of ice pick acne scars in darker skin types

Acne scars are difficult to treat. Chemical reconstruction of skin scars (CROSS) is a technique using high strength trichloroacetic acid (TCA) focally on the atrophic acne scars to induce collagenization and cosmetic improvement. The aim of this study was to evaluate the efficacy and safety of CROSS technique using 100% TCA in ice pick scars in dark skin types IV and V. Thirty patients with ice pick acne scars were initially primed for 2 weeks before the procedure. The priming agents used were hydroquinone 4% applied in the morning and tretinoin 0.025% in the night. Sunscreens were advised to prevent postinflammatory hyperpigmentation. Subsequently, they underwent focal application of 100% TCA with a wooden toothpick in each individual scar, at 2 weekly intervals, for four sessions. Improvement was assessed by the physician, photographic assessment by an independent investigator, and patient feedback by visual analogue scale after the fourth treatment. Excellent improvement (more than 70%) was observed in the majority of patients (73.3%), while 20% patients showed good improvement (50-70%) and 6.7% patients had fair results (30-49%) at the end of four sessions. Transient hypopigmentation was observed in one patient and hyperpigmentation in two patients. However, no significant adverse effects such as prolonged pigmentary changes or scarring were noted. Treatment of ice pick acne scars with the CROSS technique using high strength 100% TCA is a safe, minimally invasive, efficacious, and cost-effective technique in darker skin. Adequate priming and continued use of hydroquinone and tretinoin reduces complications and promotes healing.