Risk of Hypopigmentation in TCA Cross

Question

I was planning to get TCA Cross on my scars, but one doctor told that I risk hypopigmentation. Is this true?

David Hansen, MD · Answer

TCA peels do help scars, especially icepick ones but run a small risk of hypopigmentation which is usually temporary. Don't let that risk detract you from improving your scars.

Larry S. Nichter, MD, MS, FACS · Answer

TCA Cross can result in both hypopigmentation and hyperpigmentation
We do not offer the "TCA Cross" treatment at use of 100% TCA is potentially dangerous, unpredictable, and more likely to cause permanent loss of pigmentation or more likely post inflammatory hyperpigmentation (dark spots) like you are experiencing and potentially other scarring. Patients with dark skin types are more likely to experience this side effect. These dark spots can often be prevented by pre and post treatment with hydroquinone or other whitening agents, lasers etc.There are other methods in my hands that seem to work better including "diamond wire" undermining or direct mini-excision of acne pits under magnification to leave a flat scar.

Michael H. Swann, MD · Answer

The CROSS technique is effective for acne scars with high potency TCA. It does make an initial wound and the epidermolysis (shedding of the top layer of skin) does appear "frosted" immediately after treatment. Pigment changes (both lightening and darkening) do occur and high potency TCA is not for all skin types. In experienced hands repeated treatments with TCA Cross offers good results.

Samir Shureih, MD · Answer

Even Carbon dioxide laser resurfacing have limited improvement on real deep ice pick scars.
Depending on your color and how the skin is prepared hypo and hyperpigmentation can occur.
Review the medical literature on real ice pick scars.

Risk of Hypopigmentation in TCA Cross

Answers (4)

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