What is the recommended treatment for deep icepick scars using TCA (Trichloroacetic Acid) CROSS?

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Last updated: June 21, 2025View editorial policy

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From the Research

The recommended treatment for deep icepick scars using TCA CROSS involves applying high-concentration trichloroacetic acid precisely to the base of each scar, typically using 90% TCA, with a wooden applicator or toothpick, and repeating the treatment every 4-6 weeks for 3-6 sessions, as supported by the study published in 2010 1.

Key Considerations

  • The procedure begins with cleansing the face and applying petroleum jelly around the scars to protect surrounding skin.
  • Using a wooden applicator or toothpick, the physician carefully deposits a tiny amount of TCA solution into each icepick scar, avoiding overflow onto normal skin.
  • A white frosting reaction indicates proper application.
  • Post-procedure care includes gentle cleansing, strict sun protection, and moisturizing.
  • Patients should expect temporary redness, crusting, and darkening that resolves within 5-7 days.

Efficacy and Safety

  • The study published in 2010 1 demonstrated that the CROSS technique with 100% TCA is a safe, efficacious, cost-effective, and minimally invasive technique for the management of ice pick acne scars.
  • Another study published in 2014 2 compared the efficacy of platelet-rich plasma, CROSS technique with 100% trichloroacetic acid, and combined skin needling and platelet-rich plasma in the treatment of atrophic acne scars, and found that all three modalities showed promising efficacy and safety.

Important Notes

  • The study published in 2021 3 highlighted the importance of using a precision applicator, such as a 30-gauge needle, to prevent TCA spread to adjacent healthy skin and worsening of acne scars.
  • The choice of TCA concentration and treatment protocol may vary depending on the individual patient's needs and response to treatment, as noted in the study published in 2008 4.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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