CROSS Technique (TCA Cross)

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 surrounding skin. During application, the chemical peel is applied by pressing hard for a few seconds, using a sharpened wooden applicator, until a white frosting appears. TCA concentrations greater than 50% increase the efficacy of the peel because of increased thickening of the skin and collagen production.

Good or Excellent Response

Strength of Evidence
1
2
3
4
5
65% of patients achieved a good (>50%) or excellent (>75%) improvement in scarring after 3 - 4 sessions

Moderate Response

Strength of Evidence
1
2
3
4
5
87% of patients achieved at least a moderate (>25%) improvement in scarring after 3 - 4 sessions
  1. Veenstra, J. J., Fakhoury, J. W. & Ozog, D. Worsening of acne scars from trichloroacetic acid CROSS delivered via micropipette: a case report. J Clin Aesthet Dermatol 14, 41–42 (2021).
  2. Sheraz, S., Gul, M. S. & Kamal, K. Efficacy of dermaroller vs trichloroacetic acid (TCA) CROSS technique for treatment of acne scars. PAFMJ 71, 895–98 (2021).
  3. 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).
  4. 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).
  5. Pooja, T., Gopal, K. V. T., Rao, T. N., Devi, B. G. & Kumar, S. A. A randomized study to evaluate the efficacy fractional CO2 laser, microneedling and platelet rich plasma in post-acne scarring. Indian Dermatol Online J 11, 349–354 (2020).
  6. 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).
  7. 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).
  8. 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).
  9. 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).
  10. 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).
  11. 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).
  12. 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).
  13. 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).
  14. Kim, H. J., Kim, T. G., Kwon, Y. S., Park, J. M. & Lee, J. H. Comparison of a 1,550 nm Erbium: glass fractional laser and a chemical reconstruction of skin scars (CROSS) method in the treatment of acne scars: a simultaneous split-face trial. Lasers Surg Med 41, 545–549 (2009).
  15. Fabbrocini, G., Cacciapuoti, S., Fardella, N., Pastore, F. & Monfrecola, G. CROSS technique: chemical reconstruction of skin scars method. Dermatol Ther 21 Suppl 3, S29-32 (2008).
  16. Yug, A., Lane, J. E., Howard, M. S. & Kent, D. E. Histologic study of depressed acne scars treated with serial high-concentration (95%) trichloroacetic acid. Dermatol Surg 32, 985–990; discussion 990 (2006).
  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

Medium
Medium side effects and adverse reactions

Reviews

3.7
21 Reviews