CROSS Technique (TCA Cross)

Immediately after treatment:

  • Right after treatment with the CROSS technique, the skin will sting or burn. The skin in the treated area may become red and/or swollen. The treated scars themselves will be white or have a “frosted” appearance.
  • After treatment, the doctor may prescribe an antibiotic that will need to be applied until crusts form on top of the treated scars.
  • No dressings are necessary after treatment with the CROSS technique.

Days and weeks after treatment:

  • In the days after treatment, if your doctor has prescribed an antibiotic, you will need to apply it to the treated scars until crusts form.
  • Crusts will form on top of the treated scars 1-3 days after treatment. These crusts will shed spontaneously in 5-7 days.

CAUTION: Detaching the crusts may increase the likelihood of side effects such as skin coloration changes (hypo- or hyperpigmentation). Instead of detaching the crusts yourself, wait for them to fall off on their own.

  • It is important to avoid sun exposure and apply sunscreen for 1 month after the treatment.
  • You may use make-up to camouflage skin redness and other side effects while your skin heals.

Longer term:

The most common long-term complications of treatment with the CROSS technique are persistent skin redness (erythema) and skin coloration changes, especially skin darkening (hyperpigmentation).

References
  1. Levy LL, and Zeichner JA. Management of acne scarring, part II. A comparative review of non-laser-based, minimally invasive approaches. Am J Clin Dermatol. 13(5), 331-340 (2012).
  2. Kontochristopoulos G, and Platsidaki E. Chemical peels in active acne and acne scars. Clin Dermatol. 35(2), 179-182 (2017).
  3. Lee JB, Chung WG, Kwahck H, and Lee KH. Focal treatment of acne scars with trichloroacetic acid: chemical reconstruction of skin scars method. Dermatol Surg. 28(11), 1017-21 (2002).
  4. Bhardwaj D, and 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(2), 93-6 (2010).
  5. Agarwal N, Gupta LK, Khare AK, Kuldeep CM, and Mittal A. Therapeutic response of 70% trichloroacetic acid CROSS in atrophic acne scars. Dermatol Surg. 41(5), 597-604 (2015).
  6. Ahmed R, Mohammed G, Ismail N, and 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(1), 8-13 (2014).
  7. Khunger N, Bhardwaj D, and 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(1), 51-7 (2011).
  8. Nofal E, Helmy A, Nofal A, Alakad R, and 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. Dermatol Surg. 40(8), 864-73 (2014).
  9. Dalpizzol M, Weber MB, Mattiazzi AP, and Manzoni AP. Comparative Study of the Use of Trichloroacetic Acid and Phenolic Acid in the Treatment of Atrophic-Type Acne Scars. Dermatol Surg. 42(3), 377-83 (2016).
  10. Ramadan SA,  El-Komy MH, Bassiouny DA, and El-Tobshy SA. Subcision versus 100% trichloroacetic acid in the treatment of rolling acne scars. Dermatol Surg. 37(5), 626-33 (2011).
  11. Uptodate.com The management of acne scars. Available from: https://www-uptodate-com.eresources.mssm.edu/contents/management-of-acne-scars?source=search_result&search=management%20of%20acne%20scars&selectedTitle=1~27#. Last retrieved: 26 September 2017.