134 replies to this topic

[Anna]

A new treatment exists for Ice Pick Scars other than subcision. It is being performed by a Dr. Rapaport in NJ. The treatment consists of placing a small drop of 60-100% trichloracetic acid (TCA) into each pit. About three treatments are needed

[stefany]

Is there more information on this? How did you hear of this?

[Anna]

Somebody on the Acne Scar Voy mentioned it in passing so I called Dr. Rapaport's office and they described it to me. What I posted is all I know.
Sorry.

[drift]

i read voy forum post. can someone actually verify the results of this treatment?

[Henry]

There seems to be a consensus that icepicks are the most difficult acne scars to treat.

If Dr. Rapaport has found something that works, it would constitute a real breakthrough.

I therefore agree that some verification and explanation would be of great benefit to the board.

[Anna]

I live in Seattle, so when I called Dr. R's office after reading the post on the Voy I was wondering if their office knew anyone in my area who provided this service. They suggested I go to the AAD website. I did and unfortunately most of the doctors around here don't even know what subscision is. (In my first post I meant excision, as that is the current treatment for icepicks). Sorry for the confusion.

If somebody lives in NJ and has this treatment I agree it would be great to get a first hand account. I may call Dr. R's office back and ask them if they are aware of any medical textbook that details this treatment so that I could have a doctor here consider it. I would hate to be the guinea pig though. You would think they must have done studies before they started providing this treatment.

[Anna]

OK, I called Dr. R's office again and they were nice enough to tell me that the treatment Dr. R is doing for icepicks was detailed in the November 2002 Journal for Dermatologic Surgery. Here is a link to view the abstract:

http://www.blackwell...25.2002.02095.x

You have to pay $19.00 online to view the whole thing. My guess is any PS or derm already subscribes.

[FrankY]

whats his web site?

[stefany]

I went ahead and paid to view the full article. Looks extremely successful. This method is called the CROSS method, which consists of focal application of 65% and 100% TCA by pressing hard on the entire depressed area using a sharpened wooden applicator. Looks just like a long toothpick. No anaesthetic was needed. Each scar was treated until it reached a "frosted" appearance after one application. After CROSS, an antibiotic ointment is used over scars. This treatment was performed again every 1-3 months to allow dermal thickening and collagen production. Results showed that the 100% TCA application had excellent results after 6 applications in ALL of the patients. In the 65% TCA
application, ALL of the patients experienced good or excellent results after 6 treatments. No complications were noted in the 65 patients. This method is superior to a full-face TCA peel, because this AVOIDS the risk for scarring and hypopigmentation by sparing healthy skin. The article concludes that repeated CROSS application can normalize deep rolling and boxcar acne scars, and a similar result can be achieved for deep icepick scars with higher TCA concentrations. Moreover, it is said to be effective for ALL deep acne scar types. Sounds exciting!! It even stated that people on accutane can have this method performed because it spares normal skin. But they are doing further studies on that. Sorry for the book, but it is a very intriguing article. Now I am going to find out who performs this procedure. Why get dermabrasion or laser peels that really don't come close to this method!

[Anna]

Dr. Rapaport's web site is:

http://www.jrapaport.com/

[FrankY]

am i the only one excited ab this???

[freedom]

Can you describe exactly what the tongue depressor does/is needed for? I dont get that part.
What type of scars responded best to this treatment? Any 100% improvements? What if I have hundreds of tiny pits all next to each other, will this work for this?

[stefany]

I can't explain exactly what "pressing hard" means, but that is how they explained it. This is an exact quote: "An analysis was conducted of 65 patients with atrophic acne scars who were treated with the CROSS method in our hospitals between July 1996 and July 2001. The Cross method consists of the focal application of higher TCA concentrations by pressing hard on the entire depressed area of atrophic acne scars using a sharpened wooden applicator."

Sounds like this tool is used to disperse the TCA further in to the acne scar. It stated that all acne scars benefit the same with the 100% TCA after 6 treatments. It also said that this treatment has been used for over 10 years in Korea. What is taking us so long?

[Anna]

Hi All!

I went ahead and paid the $19.00 too. Anyway, it all looks very promising, but then so did Exoderm. I hate to pop anyone's balloon.

Nonetheless, I have an appointment with a new dermatologist on March 13th. (I have given up on Plastic Surgeons as they only seem interested in high ticket fast turnover procedures like breast implants, etc.) I will walk into the office with my little paper and see if I can convince them to give this a procedure a try on one of the icepick scars on my nose.

I keep re-reading the article as it does seem too good to be true. I have to force myself not to be excited as I cannot bear another disappointment.

Of course I will let everyone know what the doctor has to say!

Please keep your fingers crossed, not just for me, but for all of us!
Anna

[stefany]

That sounds great! Please let us know what happens. I forwarded a copy to my doctor to see if he will consider performing it on me too. It really does look promising. I will let you know what happens too.

[freedom]

Thanks for the clarification.
Can anyone think of any problems this might pose skinwise?

[dilemma]

I have been diligently following all the messages on this board for months now but was happy to just read and learn about what to do with my scars. After reading that this method has been used in Korea for a long time though, I thought I might have something to contribute. I am Korean by birth and read and write Korean moderately well. I thought I would do some research on this icepick treatment method on the Korean search engines and see what I come up with.

First of all, this method does seem to be quite common. While I only did the search using "acne scar treatment", I came up with a whole list of dermatologists' offices (called "clinics" in Korea) which provided this treatment. Most of the clinics have websites and while they do not go into detail on how each treatment method is performed, they offered information on various methods of scar treatment.

The medical term is the CROSS method but it went by a lot of names - TCA (trichloroacetic acid) peel, dot peel and spot peel. It is explained as being effective for most types of scars, especially deep, icepick ones. The procedure is as explained in previous messages - a drop of TCA is dropped into the scar (no mention of a toothpick though), the scar forms a brown scab, which falls off naturally in 7-10 days. They caution you never to pick at the scab, and that the longer the scab stays on your skin, the more satisfactory the result will be.

You can wash your face with soap that very day and wear makeup. They recommend getting the treatment 3-5 times on a monthly basis for a "satisfactory" result. You also have to apply some sort of special cream/gel on the scar after the scab falls off, right up until your next treatment. I am guessing this is to encourage collagen growth. Numbing of the skin is not required and all the doctors describe is as a simple procedure. You have to wear a sunscreen after the scab falls off and some doctors do warn of discoloration/redness of the scar area but that the redness usually goes away on its own.

Another interesting thing is the the doctors seem to recommend this "dot peel" combined with laser treatments, most commonly the Erbium-Yag laser, which apparently minutely cuts away at the depth of the scar, thereby making it shallower and easier to see better results using the TCA peel.

There were other treatments I had never heard of - using electric stimulation on scars and something called a seaweed peel. I felt like jumping on a plane and fly straight into one of those clinics.

Hope this helped. It is not a first-hand tale of success but I'm hoping it does provide information on what this procedure does. Good luck everyone! 8)

[stefany]

Dilemma, thanks for that great bit of information! After I e-mailed the study in "Dermatologic Surgery" to my physician, he said he would look in to it. But for now, he is reccomending this new Erbium long-pulsed laser called the Sciton laser. Apparently, it is supposed to be good for atrophic acne scarring. I don't know. I get so confused by all of these methods. But for some reason, this CROSS method has me very excited. Please let us know if you find out anything else!

[Anna]

Hi Dilemma,
Thanks for your research! I wonder if there is any way to find out what type of cream you are supposed to use after the crust falls off?
Thanks again!
Anna

[freedom]

This Cross Method sounds like it would be very simple to do on our own. Does anyone know how or where to obtain 100% TCA?

Dilemma, you mentioned that they let the wound scab, does this imply that no moisture such as vasoline was used after the procedure? Studies have indicated that skin growth is faster and more complete when kept moist. Can you comment?

I would think that applying copper peptides after such a procedure would be best.