CROSS Technique (TCA Cross)

Compare To Other Treatments

What Is It?

“CROSS” stands for “Chemical Reconstruction Of Skin Scars.” A chemical peel, usually trichloroacetic acid (TCA), is applied directly on the area of the acne scar in order to maximize the effects of the chemical peel and to spare the surrounding skin. During application, the chemical peel is either (1) applied by pressing hard for a few seconds, using a sharpened wooden applicator, until a white frosting appears, or (2) injected directly into scars. TCA concentrations greater than 50% increase the efficacy of the peel because of increased thickening of the skin and collagen production.

This procedure is normally repeated 4 times in 2-week intervals.

Results

Results
Strength of Evidence: Moderate
64% of patients achieved a good (>50%) or excellent (>75%) improvement in scarring after 3 - 4 sessions
Expand for result statistics
Good or Excellent Response
64% of patients achieved a good (>50%) or excellent (>75%) improvement in scarring after 3 - 4 sessions
Moderate Response
91% of patients achieved at least a moderate (>25%) improvement in scarring after 3 - 4 sessions
▸ Based on These Clinical Studies & Trials
▾ Based on These Clinical Studies & Trials
  1. Soysal, M. Ç. & Akçalı, C. Comparison of 70% and 100% concentration of trichloroacetic acid peeling efficacy with chemical reconstruction of skin scars technique in atrophic acne scar treatment. Arch Dermatol Res 317, 547 (2025).
  2. Lakra, S., Mawlong, P. G. & Bisht, N. Comparative evaluation of the effectiveness and safety of trichloroacetic acid chemical reconstruction of skin scars versus microneedling in facial atrophic acne scars. Asian Journal of Medical Sciences 16, 69–75 (2025).
  3. Roy, G., Gayen, T., Sen, S. & Rudra, O. Study to compare the efficacy of 50% glycolic acid with 65% trichloroacetic acid in the treatment of atrophic acne scar by CROSS technique. JCAS 17, 198–204 (2024).
  4. Dac Thuy, L. N., Thuy Trang, V. T., Tran, N. N. & Phuong Thao, D. T. Comparing the use of 80% trichloroacetic acid and 50% trichloroacetic acid for the treatment of ice pick acne scars. Dermatol Surg 50, 847–850 (2024).
  5. Asif, A. et al. A comparison of treatment efficacy of chemical reconstruction of skin scars with 50% trichloroacetic acid peel and microneedling in acne scars. J Pak Assoc Dermatol 34, 159-164. (2024).
  6. Sharma, P. & Sharma, R. A comparative analysis of microneedling and TCA CROSS for management of atrophic acne scars. Sch J App Med Sci 10, 281–285 (2022).
  7. Mumtaz, M. et al. Comparing the efficacy of intra-dermal platelet rich plasma (PRP) versus 50% trichloracetic acid (TCA) using CROSS technique for atrophic acne scars. J Coll Physicians Surg Pak 31, 55–59 (2021).
  8. Ullah, I., Paracha, M., Zahoor, H. & Khan, D. Efficacy and safety of cross technique with 100% TCA and Dermaroller technique in the treatment of post acne scars. J Med Sci 28, 68–71 (2020).
  9. Dalpizzol, M., Weber, M. B., Mattiazzi, A. P. F. & Manzoni, A. P. D. Comparative study of the use of trichloroacetic acid and phenolic acid in the treatment of atrophic-type acne scars. Dermatol Surg 42, 377–383 (2016).
  10. Agarwal, N., Gupta, L. K., Khare, A. K., Kuldeep, C. M. & Mittal, A. Therapeutic response of 70% trichloroacetic acid CROSS in atrophic acne scars. Dermatol Surg 41, 597–604 (2015).
  11. Nofal, E., Helmy, A., Nofal, A., Alakad, R. & Nasr, M. Platelet-rich plasma versus CROSS technique with 100% trichloroacetic acid versus combined skin needling and platelet rich plasma in the treatment of atrophic acne scars: a comparative study. Dermatologic Surgery 40, 864–873 (2014).
  12. Ahmed, R., Mohammed, G., Ismail, N. & Elakhras, A. Randomized clinical trial of CO₂ laser pinpoint irradiation technique versus chemical reconstruction of skin scars (CROSS) in treating ice pick acne scars. J Cosmet Laser Ther 16, 8–13 (2014).
  13. Ramadan, S. A. E.-R., El-Komy, M. H. M., Bassiouny, D. A. & El-Tobshy, S. A. Subcision versus 100% trichloroacetic acid in the treatment of rolling acne scars. Dermatol Surg 37, 626–633 (2011).
  14. Leheta, T., El Tawdy, A., Abdel Hay, R. & Farid, S. Percutaneous collagen induction versus full-concentration trichloroacetic acid in the treatment of atrophic acne scars. Dermatol Surg 37, 207–216 (2011).
  15. Khunger, N., Bhardwaj, D. & Khunger, M. Evaluation of CROSS technique with 100% TCA in the management of ice pick acne scars in darker skin types. J Cosmet Dermatol 10, 51–57 (2011).
  16. Bhardwaj, D. & Khunger, N. An assessment of the efficacy and safety of CROSS technique with 100% TCA in the management of ice pick acne scars. J Cutan Aesthet Surg 3, 93–96 (2010).
  17. Lee, J. B., Chung, W. G., Kwahck, H. & Lee, K. H. Focal treatment of acne scars with trichloroacetic acid: chemical reconstruction of skin scars method. Dermatol Surg 28, 1017–1021; discussion 1021 (2002).

Side Effects

Side Effects
Medium side effects and adverse reactions

Reviews

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4.4
9 Reviews

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