Scribd
Upload
67 views

Tca 80% Boxcar

This article describes a case of atrophy developing as a complication from using the cross-technique (chemical reconstruction of skin scars method) with trichloroacetic acid (TCA) to treat boxcar acne scars. A 28-year-old woman underwent two applications of 80% TCA acid 30 days apart targeting ice pick and boxcar scars, which resulted in improvement of some scars but also development of atrophy in others. The atrophic areas gradually improved over the next 2 months without further treatment. The article discusses TCA as a treatment for acne scars and reports this adverse effect as an important complication to recognize to better understand the risks of this therapy.

Uploaded by

saad sohail
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
67 views

Tca 80% Boxcar

This article describes a case of atrophy developing as a complication from using the cross-technique (chemical reconstruction of skin scars method) with trichloroacetic acid (TCA) to treat boxcar acne scars. A 28-year-old woman underwent two applications of 80% TCA acid 30 days apart targeting ice pick and boxcar scars, which resulted in improvement of some scars but also development of atrophy in others. The atrophic areas gradually improved over the next 2 months without further treatment. The article discusses TCA as a treatment for acne scars and reports this adverse effect as an important complication to recognize to better understand the risks of this therapy.

Uploaded by

saad sohail
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 4

See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/47754426

Complication of Cross-Technique on Boxcar Acne Scars: Atrophy

Article  in  Dermatologic Surgery · November 2010


DOI: 10.1111/j.1524-4725.2010.01820.x · Source: PubMed

CITATIONS READS

8 14,414

5 authors, including:

Magda Blessmann Weber Ana Paula Dornelles da Silva Manzoni


Universidade Federal de Ciências da Saúde de Porto Alegre Universidade Federal de Ciências da Saúde de Porto Alegre
67 PUBLICATIONS   827 CITATIONS    28 PUBLICATIONS   231 CITATIONS   

SEE PROFILE SEE PROFILE

Some of the authors of this publication are also working on these related projects:

Master View project

All content following this page was uploaded by Ana Paula Dornelles da Silva Manzoni on 04 April 2018.

The user has requested enhancement of the downloaded file.


Complication of Cross-Technique on Boxcar
Acne Scars: Atrophy
MAGDA BLESSMANN WEBER, MD, PHD, RAQUEL BOZZETTO MACHADO, MD,
ISADORA ROSA HOEFEL, MD,y ANA PAULA DORNELLES MANZONI, MD, MS,z AND
ARIANE DA SILVA BASTOS GELER, MDy

The authors have indicated no significant interest with commercial supporters.

Trichloroacetic Acid Scars treatment for severe cystic-nodule acne controlled us-
ing ethinyl estradio-cyproterone acetate oral contra-

A cne is a common skin condition that affects


up to 80% of young people age 11 to 30.
It is characterized by cornification of the follicular
ceptives associated with the use of topical retinoic acid
0.025%, but many ice pick– and boxcar-type scars
remained in the malar regions (Figure 1), so the deci-
infundibulum in association with sebaceous hyper-
sion was made to begin application of 80% trichloro-
secretion and sebaceous retention, proliferation of
acetic acid (day 0). Treatment was initiated on the left
bacteria, and inflammation.1 The main complication
malar region, with the application of 80% TCA acid
of acne is scarring, which tends to cause significant
within the scar, using a sharpened applicator to deliver
aesthetic discomfort for patients. It is also cited as
the TCA acid deeply, which had a whitening effect.
causing or aggravating psychosocial disorders.2
After 30 days, the patient returned and was pleased
with the result. A second application was given in the
There has been much research into the treatment of
same manner as the first, but upon her return 1 month
acne scars in an attempt to minimize them. Recently,
later, the patient presented areas of atrophy in some of
the focal application of trichloroacetic (TCA) acid,
the treated scars (Figure 2) and improvement in others.
called the chemical reconstruction of skin scars
It was decided to suspend the treatment and observe
(CROSS) method, has been proposed and has shown
the evolution of the clinical complication. After 2
good clinical results in ice pick–type scars.3,4 These
months more, the atrophic areas were less evident and
scars result from tissue damage and form small-
showed a naturally favorable evolution (Figure 3).
diameter (o2 mm) but deep depressions. At high con-
centrations (50–90%) right in the scar, CROSS causes
the reorganization of the dermis and increases dermal
Discussion
volume through the production of collagen,
glycosaminoglycans, and elastin,5 although it is not a The treatment of acne scars has been based mainly
risk-free procedure, and its complications should be on the use of chemical peels, dermabrasion, and
reported to ensure better understanding of this therapy. more recently, laser. These methods tend to require
longer recovery periods, greater risk of complica-
tions, and greater costs to the patient.1 In contrast,
Case Report
with the application of high concentrations of TCA
A 28-year-old, white woman with a history of acne acid, the recovery time is shorter, and patients do not
since the age of 16 was undergoing dermatologic need to interrupt their daily activities.5,6 This is due

Departments of Dermatology and yAcademic Medicine, Universidade de Ciências da Saúde de Porto Alegre, Porto
Alegre, RS, Brazil; zDepartment of Dermatology, Universidade Luterana do Brasil, Porto Alegre, Brazil; yUniversidade
Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil

& 2010 by the American Society for Dermatologic Surgery, Inc.  Published by Wiley Periodicals, Inc. 
ISSN: 1076-0512  Dermatol Surg 2010;36:1–3  DOI: 10.1111/j.1524-4725.2010.01820.x

1
C O M P L I C AT I O N O N B O X C A R A C N E S C A R S

Figure 1. Ice pick– and boxcar-type scars in the malar re- Figure 2. Atrophy in some of the treated scars, after second
gions before treatment. application.

to its use in minimal spaces, surrounded by intact


skin that facilitates rapid healing.4 In their study,
Cho and colleagues suggest that treatment of atro-
phic scars using the CROSS method is more bene-
ficial than simple application of TCA acid,7 because
TCA acid is delivered deeper into the dermis. In
addition, TCA acid is a low-cost material.5 Adverse
effects with the use of TCA acid have been docu-
mented, including erythema, hypo- and hyper-
pigmentation, scarring, and development of hyper-
trophy and atrophy.3 The atrophy produced by TCA
acid looked similar to that sometimes generated by
intralesional corticosteroids.6 Also, similar to steroid
injection, the atrophy produced by TCA acid showed
spontaneous clinical improvement.7

Conclusion

The focal application of TCA acid in acne scars using Figure 3. Hypochromic scars 120 days after the first
the CROSS method is a simple and valid therapeutic application of TCA acid.

2 D E R M AT O L O G I C S U R G E RY
WEBER ET AL

method, although it is not free from side effects. 4. Lee JB, Chung WG, Kwahck H, Lee KH. Focal treatment of acne
scars with trichloroacetic acid: chemical reconstruction of skin
These should be well known to physician so that scars method. Dermatol Surg 2002;28:1017–21.
they can manage them and guide their patients.
5. Fabbrocini G, Cacciapuoti S, Fardella N, et al. CROSS technique:
This case demonstrates an adverse effect of self- chemical reconstruction of skin scars method. Dermatol Ther
limited course that can, at first, only be observed 2008;21(s3):S29–32.

clinically. 6. Rivera AE, Missouri K. Acne scarring: a review and current treat-
ment modalities. J Am Acad Dermatol 2008;59:659–76.

7. Cho SB, Park CO, Chung WG, et al. Histometric and histochemical
analysis of the effect of trichloroacetic acid concentration in the
References
chemical reconstruction of skin scars method. Dermatol Surg
1. Carniol PJ, Vynatheya J, Carniol E. Evaluation of acne scar treat- 2006;32:1231–6.
ment with a 1450-nm midinfrared laser and 30% trichloroacetic
acid peels. Arch Facial Plast Surg 2005;7:251–5.

2. Kellett SC, Gawkrodger DJ. The psychological and emotional


impact of acne and the effect of treatment with isotretinoin. Br J Address correspondence and reprint requests to: Magda
Dermatol 1999;140:273–82. Blessmann Weber, MD, PhD, Av Neuza Brizola, 495/301,
90460-230, Porto Alegre- RS, Brazil, or e-mail:
3. Alam M, Dover JS. Treatment of acne scarring. Skin Ther Lett
[email protected]
2006;11:7–9.

36:**:2010 3

View publication stats

You might also like