TCA CROSS in Cagliari: Acne Scar Treatment

What the TCA Cross Technique Is

TCA CROSS — where CROSS stands for Chemical Reconstruction Of Skin Scars — is a technique developed specifically for treating deep atrophic ice-pick scars. Trichloroacetic acid (TCA) is applied at a high concentration (typically 70-100%) exclusively inside the scar, without involving the surrounding healthy skin, using a fine and precise instrument.

The action of the acid produces a controlled necrosis localised at the base of the scar, which triggers the synthesis of new collagen and the progressive filling of the skin defect from the bottom upwards. The result is a progressive flattening of the scar, with a visible improvement in skin texture.

Types of Scars That Can Be Treated

TCA Cross is particularly effective for atrophic post-acne scars, in particular:

• Ice-pick scars: narrow, deep, with sharp edges — the prime indication for TCA Cross
• Narrow boxcar scars: small, flat-based depressions with vertical edges
• Some chickenpox scars of the same type

For larger scars or scars of a different type (rolling, wide boxcar), complementary treatments such as fractional CO2 laser, microneedling, medium-depth chemical peels or subcision are often indicated. A combined approach generally offers the best results.

How the Session Works

Initial Assessment

The first visit involves the clinical analysis of the scars, classification of the type (ice-pick, boxcar, rolling, mixed), assessment of the skin phototype and definition of a personalised treatment plan.

Procedure

The area is cleansed thoroughly. Trichloroacetic acid is applied focally inside each scar with a dedicated instrument, creating a characteristic "white frosting" that indicates correct penetration. The sensation is a brief, localised stinging, generally well tolerated. A session typically lasts 15-30 minutes depending on the number of scars treated.

After the Session

In the first 3-7 days small pinpoint crusts form at the treated points, which shed spontaneously. It is essential not to remove them manually. Application of soothing creams and strict SPF 50+ sun protection is recommended. You can generally return to normal social activities straight away.

How Many Sessions Are Needed

The number of sessions varies according to the depth and number of scars. Generally 3-6 sessions spaced 4-8 weeks apart are planned. Results are progressive: each session produces a small amount of new collagen, and the improvement becomes fully visible several months after the last session.

TCA Cross or Fractional CO2 Laser?

They are two complementary treatments, not alternatives. TCA Cross is the technique of choice for deep ice-pick scars, where its focal precision is unmatched. The fractional CO2 laser acts on the entire surface and is ideal for improving overall texture, boxcar and rolling scars, and for stimulating a global remodelling of the skin.

In clinical practice, many patients benefit from a combined approach that integrates both techniques at different points in the treatment journey.

Who Is the Ideal Candidate

TCA Cross is indicated for patients with post-acne ice-pick scars, with acne in remission, willing to commit to a course of several sessions. It is not recommended during pregnancy and breastfeeding, in the presence of severe uncontrolled active acne, of an active cold sore in the area to be treated, and in patients prone to keloid formation.