Subcision versus 100% trichloroacetic acid in the treatment of rolling acne scars.

Background: Acne scarring is common but surprisingly difficult to treat. Newer techniques and modifications to older ones may make this refractory problem more manageable. The 100% trichloroacetic acid (TCA) chemical reconstruction of skin scars (CROSS) method is a safe and effective single modality for the treatment of atrophic acne scars, whereas subcision appears to be a safe technique that provides significant improvement for rolling acne scars.

Objective: To compare the effect of the 100% TCA CROSS method with subcision in treating rolling acne scars.

Methods: Twenty patients of skin types III and IV with bilateral rolling acne scars received one to three sessions of the 100% TCA CROSS technique for scars on the left side of the face and subcision for scars on the right side.

Results: The mean decrease in size and depth of scars was significantly greater for the subcision side than the 100% TCA CROSS (p<.001). More side effects in the form of pigmentary alteration were observed with the 100% TCA CROSS method.

Conclusion: For rolling acne scars in patients with Fitzpatrick skin types III and IV, subcision shows better results with fewer side effects than the 100% TCA CROSS technique, although further decrease in scar depth with time occurs more significantly after 100% TCA CROSS.