Use of Trichloroacetic Acid in Treatment of Atrophic Acne Scars: A Scoping Review

BACKGROUNDAtrophic acne scars represent a significant aesthetic and therapeutic challenge due to their multifactorial nature and morphological diversity. Trichloroacetic Acid (TCA) stands out as a versatile option, either through chemical peels or the Chemical Reconstruction of Skin Scars (CROSS) technique.

AIMTo map scientific evidence regarding clinical protocols, concentrations, and efficacy of TCA, alone or in combined therapies, for atrophic acne scars.

METHODSThis scoping review followed the Joanna Briggs Institute (JBI) methodology and PRISMA-ScR guidelines. Search strategies were applied across nine databases using the PCC strategy. Thirty-four studies published between 2002 and 2025 were included.

RESULTSThe CROSS technique was the most evaluated protocol (58.8% of studies), with concentrations ranging from 50% to 100%; it demonstrated high selectivity and efficacy, particularly for ice-pick and deep boxcar scars. Chemical peels accounted for 41.2% of studies, with superficial concentrations (10%–20%) used for texture improvement and medium concentrations (25%–50%) for shallow atrophic lesions. Combined therapies (52.9%) highlighted the synergy between TCA (15%–20%), microneedling, and subcision. Reported adverse events were primarily transient, including post-inflammatory hyperpigmentation (PIH) and prolonged erythema.

CONCLUSIONTCA is a versatile, cost-effective, and evidence-backed tool. The findings highlight a definitive shift toward personalized multimodal approaches, where the CROSS-technique's precision and the synergistic effects of combined therapies optimize dermal remodeling and patient outcomes.

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