What is TCA CROSS

Trichloroacetic (TCA) acid is a chemical which causes inflammation when applied to the surface of the skin. TCA CROSS stands for TCA chemical reconstruction of skin scars. This involves the precise application of small amounts of TCA to the base of atrophic (depressed) acne scars. This triggers the wound healing response which can lead to the depressed scar filling out and becoming less noticeable.

TCA CROSS is used for atrophic acne scars such as boxcar and rolling scars. In most cases more than one treatment is required.

Multiple areas can be treated in a single session. Following treatment the area will be red and sore for 5-7 days. You should apply Vaseline regularly until the treated areas have healed. Risks include persistent redness, increased pigmentation (post-inflammatory hyperpigmentation) and decreased pigmentation (hypopigmentation). Pigmentary change is more of a concern in those with darker skin types. It usually resolves spontaneously with time but very rarely can be permanent.

Alternatives include doing nothing, laser resurfacing, subcision, punch excision, dermal fillers and skin boosters.

Contraindications

It is essential to inform Dr Lynch if any of the following apply :-

1. Allergy: It is essential to inform Dr Lynch if you have an allergy to local anaesthetic, latex, dressings, cleaning solutions used in surgery or any other medications.

2. History of Scarring or Keloids: Patients who have a history of keloid formation or excessive scarring have an increased risk of poor healing.

3. Important events / travel: It is not advisable to have TCA CROSS shortly before important events such as weddings or important business meetings etc.

4. Inflammatory skin diseases such as vitiligo, psorisasis or lichen planus: If you suffer from an inflammatory skin disease, skin surgery can cause this to be triggered at the site of treatment. It is essential to inform Dr Lynch so that the risks and benefits of treatment can be discussed.

TCA CROSS is generally safe, however a small proportion of patients will experience one or more of the complications listed below. It is essential that you read the following carefully so that you can decide whether the potential benefits of the procedure(s) outweigh these risks.

General risks

• Unsightly scar: The goal of treatment is to improve the appearance of the scar however the final cosmetic appearance cannot be guaranteed since it is also determined by the natural healing process. There is a risk that the scar may be raised or lumpy (including hypertrophic or keloid scar), depressed, different in color from the adjacent skin (redder/lighter/darker), or different in texture (for example more shiny) in comparison with the adjacent skin. There may be visible, permanent marks from the stitches. Surgery in a hair-bearing site will result in permanent hair loss within the scar.
• Widening of the scar: TCA CROSS treatment can lead to the scar becoming wider.
• Pigmentary change (common): The treated area will usually be a different color in the healing phase - hyperpigmented (darker), hypopigmented (lighter) or redder than the normal skin color. In some cases this can be permanent.
• Infection: There is a small risk of infection. In most cases this can be treated with antibiotics and the site will heal well. Very rarely there can be significant infection that results in the wound coming apart requiring a longer period of healing with dressings and more significant scarring or infection with uncommon organisms that is challenging to diagnose or treat.
• Blistering, crusting: Blistering or crusting may occur at the site of treatment and this can persist for days or weeks.
• Pain: There may be pain during the procedure or afterwards. Rarely pain may persist for a longer period or fail to resolve.
• Numbness / Burning / Altered sensation: Any skin procedure can cause damage to the small sensory nerves that supply touch sensation. Usually this will improve with time but rarely it may be permanent resulting in numbness / burning / long lasting pain or altered sensation. Very rarely this can affect much larger areas of the body than the site of the treatment and can be permanent "regional pain".
• Need for revision treatment: There is a risk that you may need further surgery or other treatment to improve the appearance.
• Bleeding, bruising, haematoma formation: Rarely there may be mild bruising after the procedure.
• Allergic reaction: There is a small risk of suffering an allergic reaction to local anaesthetic or to dressings applied. Very rarely this can be serious or life-threatening or cause permenent unsightly changes to the skin at the site of treatment.

Additional risks

Fees and Samples

• In addition to the fee charged by Dr Lynch there will be a separate fee that is charged by the clinic for use of the theatres and TCA.
• All treatment can have complications that may require additional treatments. The costs of any additional treatments are not covered by the fees for this procedure. They will often be covered by medical insurance providers, however you should check this in advance.
• If you are paying for treatment yourself, it is important to be sure that you understand the fees due to Dr Lynch and for theatre usage and TCA prior to the procedure. If you are using medical insurance it is essential that you have confirmation that they have agreed to fund all procedures and fees otherwise you will be liable for these fees.

Aftercare

It is essential to follow aftercare instructions carefully to ensure the best results, minimize the risk of side effects and detect any complications early. This can be found at the following location: www.drmagnuslynch.com/postop or by following the QR code. Please save the link on your phone so that you have it available.

See the aftercare information for full details, some key points include:-

• Wound care: You will then apply vaseline (from a new pot) several times per day to aid healing and prevent scabbing. You should wash daily with an antibacterial wash such as dermol 500.
• Need to take time off work / activities / avoid travel: You will usually need to avoid exercise for a number of days after the procedure. Should a complication arise there is a risk you will need to take a longer period of time off work / normal activities. You should generally avoid long-distance travel for 2 weeks in case of complications arising.