title: Evaluation of CROSS technique with 100% TCA in the management of ice pick acne scars in darker skin types.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Dermatology & STD, VM Medical College & Safdarjang Hospital, New Delhi, India. drniti@rediffmail.com
authors.forename: Niti
authors.initials: N
authors.lastname: Khunger
authors.forename: Deepali
authors.initials: D
authors.lastname: Bhardwaj
authors.forename: Monica
authors.initials: M
authors.lastname: Khunger
mesh_terms: D000152:Acne Vulgaris / Q000150:complications*; D000293:Adolescent; D000328:Adult; D002615:Chemexfoliation / Q000379:methods*; D002921:Cicatrix / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D017060:Patient Satisfaction; D012880:Skin Pigmentation; D016896:Treatment Outcome; D014238:Trichloroacetic Acid / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D014238:Trichloroacetic Acid