ABSTRACT
BACKGROUND: Atrophic acne scars have been treated using various modalities. The CROSS (Chemical Reconstruction of Skin Scars) technique using 100% TCA has the advantage of reconstructing acne scars by focusing on dermal thickening and collagen production. However, the phenol CROSS technique is not widely used for acne scarring. OBJECTIVE: The purpose of this study was to evaluate the clinical effectiveness and safety of 100% TCA CROSS and phenol CROSS in the treatment of facial atrophic acne scars. METHODS: Twenty-four participants were randomly and equally divided into 2 groups: group 1 received 2 sessions (8 weeks apart) of 100% TCA CROSS, while group 2 received 2 sessions (8 weeks apart) of phenol CROSS. The severity of atrophic acne scarring and treatment efficacies were evaluated by standardized photography, patient satisfaction, physician global assessment, and the ECCA grading scale. Side effects were assessed at the 8- and 20-week visits. RESULTS: At the 0-, 8-, and 20-week visits, both groups showed an acceptable improvement in patient satisfaction and physician global assessment. ECCA grading scale scores improved by a mean of 22.2% (p<0.05) in group 1 and 19.1% (p<0.05) in group 2. The between-group difference in the degree of ECCA score improvement was not statistically significant (p=0.392). Complications such as pain, crust, postcrust erythema, postcrust dryness, and postinflammatory hyperpigmentation were observed in both treatment groups. However, no severe side effects occurred in either group. CONCLUSION: Both 100% TCA CROSS and phenol CROSS are effective treatment modalities for atrophic acne scarring without significant side effects.