Consent Form TCA CROSS

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. Often the scar will become wider as well as flatter.

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 rarely can be permanent.

The response to treatment is variable with some patients experiencing a good improvement without complications and other experiencing poor healing. Because of this variability it is recommended to attend for a test area of treatment first to assess how things heal. This reduces, but does eliminate the risk of complications.

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

Important information

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.

Risks of this surgery

• 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.
• 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. Usually, this will improve with time, however in some cases this can be permanent.
• Infection There is a small risk of infection. In most cases this can be treated 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 treatment to improve the appearance if you are not satisfied with the way that things heal.
• 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.

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

• 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.