Therapeutic response of 70% trichloroacetic acid CROSS in atrophic acne scars

Dermatol Surg. 2015 May;41(5):597-604. doi: 10.1097/DSS.0000000000000355.


Background: Acne scarring is a common sequela of acne for which no single treatment method is uniformly effective. The chemical reconstruction of skin scars (CROSS) therapy using high-concentration trichloroacetic acid (TCA) has shown promise as a cheap, safe, and effective modality of treatment in acne scars.

Objective: To assess the therapeutic response of 70% TCA CROSS on atrophic acne scars and to evaluate the adverse effects of this therapy.

Materials and methods: Fifty-three patients with postacne atrophic scars were treated with 70% of TCA focal application every 2 weeks by the CROSS technique and results evaluated on 3 parameters: physician assessment, patient assessment, and satisfaction level of patients, after a follow-up of 3 months.

Results: Good or excellent improvement (>50%) was seen in 66% of patients on physician and patient assessments. The patients were either very satisfied or satisfied in 81.1% of cases. Patients with predominantly boxcar scars and higher pretreatment scar severity were associated with better treatment outcomes. Age, sex, duration of scars, or type of skin did not significantly influence the treatment outcome and adverse effects.

Conclusion: The study showed that 70% of TCA is a safe and effective treatment option in all types of atrophic acne scars, especially in severe boxcar scars.

Publication types

  • Clinical Trial
  • Comparative Study

MeSH terms

  • Acne Vulgaris / complications
  • Adolescent
  • Adult
  • Chemexfoliation / methods*
  • Cicatrix / drug therapy*
  • Cicatrix / etiology
  • Dermatologic Agents / administration & dosage*
  • Dermatologic Agents / adverse effects
  • Drug Administration Schedule
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Outpatients*
  • Patient Satisfaction*
  • Risk Assessment
  • Treatment Outcome
  • Trichloroacetic Acid / administration & dosage*
  • Trichloroacetic Acid / adverse effects


  • Dermatologic Agents
  • Trichloroacetic Acid