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TCA CROSS for Ice Pick Scars


“Difficulties in treating ice pick scars, one of the many types of acne scars, are due to their deep and extended scarring into the dermis and even subcutaneous tissues. Traditional treatments such as laser resurfacing, dermabrasion, and microneedling are often not effective in reaching this depth. However, a lesser-known treatment using trichloroacetic acid (TCA) known as the TCA CROSS technique has shown promising results.

Mr. Cheng, a 35-year-old man who suffered from severe acne during his teenage years and did not receive proper treatment, now has ice pick scars. After examination, his scars were found to be primarily ice pick in type, which are notoriously difficult to treat. One potential option is the TCA CROSS technique, which may not be well known but has demonstrated positive results.

TCA is commonly used in chemical peels to improve skin tone and fine lines. However, undiluted high-concentration TCA (85-95%) has strong penetration and destructive capabilities. The TCA CROSS technique, proposed by Lee et al. in 2002, involves using a toothpick to apply 90-100% TCA to the base of the scar, destroying the entire ice pick and stimulating new collagen to fill in the depression. This is repeated 2-4 times every 4-6 weeks to gradually lighten the deep scars, followed by laser or microneedling treatment. One study found that 65% of patients experienced over 50% improvement with the CROSS technique, and there were minimal side effects.

However, this treatment carries significant risks. TCA can cause permanent scarring if applied to other areas or in excessive amounts. Additionally, there may be pigment changes or hypopigmentation. Therefore, it is essential to have a doctor administer this treatment.

Ice pick scars have traditionally been difficult to treat, but the TCA CROSS technique offers a promising option. As always, it is crucial to discuss with your doctor if this treatment is right for you.”