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New research · Dermatology
The Journal of clinical and aesthetic dermatology · 1d
Cohort studyThe Journal of clinical and aesthetic dermatology · 2026

The Use of Chemical Reconstruction of Skin Scars (CROSS) Method With Trichloroacetic Acid (TCA) for Atrophic Scars: A Comprehensive Review on Application Techniques, Adjunct Therapies, and Complications.

Scott Stratman, Helen He
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DermatologyCohort study

TCA CROSS method shows high improvement rates for atrophic scars.

The Use of Chemical Reconstruction of Skin Scars (CROSS) Method With Trichloroacetic Acid (TCA) for Atrophic Scars: A Comprehensive Review on Application Techniques, Adjunct Therapies, and Complications.

Scott Stratman et al. · The Journal of clinical and aesthetic dermatology · 2026
Background

Atrophic scars have a significant psychosocial and functional impact on quality of life.

Purpose

To evaluate the methodology, indications, efficacy, and safety profile of the TCA CROSS technique in atrophic scarring and to compare TCA CROSS outcomes to other therapeutic modalities and assesses its adjunctive use.

Methods

A PubMed literature search was performed for clinical studies evaluating TCA application in scar management; inclusion criteria focused on studies using the CROSS technique published after 2002.

n = 937 patients
50%
Results
to 80%
percentage of patients whose indented scars got better with treatment
n = 937 patients
More results

34 publications (20 clinical trials, 4 comparative/cohort studies, 4 case series, 2 case reports, and 4 expert opinions) met eligibility criteria.

TCA CROSS was primarily used for ice pick and boxcar acne scars, but it was also used for varicella and leishmaniasis scars.

More results

Application techniques varied, with fine-gauge needles and paintbrushes enabling more precise delivery.

Multiple sessions yielded greater improvement, and higher TCA concentrations increased the risk of complications.

“
Conclusion · 1 of 2

TCA CROSS is a safe, effective option for treating atrophic scars.

Conclusion · 2 of 2

Methodical application and multimodality approaches optimize patient outcomes; further research should address technique standardization and efficacy across diverse skin types.

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