Study to compare the efficacy of 50% glycolic acid with 65% trichloroacetic acid in the treatment of atrophic acne scar by CROSS technique.

Objectives: Acne scars often become challenging to treat with satisfactory results. The chemical reconstruction of skin scars (CROSS) technique has been used with high concentrations of trichloroacetic acid (TCA) which often produces unacceptable side effects. There is a dearth of data, with 50% glycolic acid (GA) for the same indication in the management of acne scars in the Indian population. This study aimed to assess the clinical response of acne scars after the application of 50% GA with that after the use of 65% TCA in a similar manner.

Material and methods: An institution-based prospective comparative study was performed with patients aged 16-45 years of either sex with acne scars and not been treated within the past 1 year. Subjects were assigned to receive one of the formulations (50% GA [Group A] and 65% TCA [Group B]). Grading of scars was done on day 1 and day 35 based on patients' assessment on a four-point visual scale and physicians' assessment by the Goodman-Baron qualitative global acne scar grading scale. The procedure was repeated every fortnightly for three such. Data were analyzed by Statistica version 6 (Tulsa, Oklahoma: StatSoft Inc. 2001).

Results: The visual improvement scale of patients showed 41.38% (n = 12) fair improvement in group A, whereas 58.06% (n = 18) showed good improvement in group B. Grading by the Goodman-Baron scale showed 9.68% (n = 3) showed four grade changes in group B.

Conclusion: Improvement is best observed with 65% TCA. Adverse effects were noted more with 65% TCA, especially acneiform eruption which was lacking in the previous studies. GA can be a safer alternative to TCA with acceptable results. Our study opens the scientific window for future research on different concentrations of GA as a CROSS agent.