25% TCA Peel and Dermabrasion Significantly Improves Acne Scar Appearance

Acne scarring on cheek
Acne scarring on cheek
The effectiveness and safety of 25% trichloroacetic acid (TCA) alone or followed by manual dermasanding for the treatment of mild and moderate acne scars was evaluated.

A superficial peel of 25% trichloroacetic acid (TCA) followed by manual dermasanding in separate sessions is effective in the treatment of mild to moderate acne scars, according to results of a study published in the Journal of Cosmetic Dermatology.

Although the combined treatment of chemical peeling and dermabrasion of the face for treatment of acne scars has been widely accepted since 1972, the efficacy of 25% TCA with dermabrasion has not yet been determined.

To establish this therapy, data from 13 patients (69.2% women) who had mild to moderate acne scars for more than1 year were analyzed. The severity of acne scars was assessed using a grading system. Scores 5 through 9 were considered mild, 10 through 14 were considered moderate, and 15 through 20 were considered severe.

Patients were treated with a single session of 25% TCA peel. Number of dermasanding treatments depended on need and consent. Hydroquinone 4% cream was applied nightly from the second week until the following session of dermasanding. Starting 5 to 7 ((days/weeks?)) after the dermabrasion treatments, patients were instructed to use hydroquinone 4% nightly as well as hydrocortisone 1% ointment twice daily for one week. Follow-up sessions occurred 1 week and 1 month after each dermabrasion session to determine if more sessions were necessary and 3 months after the last session.

TCA peeling resulted in a 13.8% reduction in acne scar severity (P =.013). At the 3-month follow-up, the 3 patients who only had 1 dermabrasion session experienced a 33% reduction in acne scar severity from the post-TCA score (P =.0002). The 3 patients who had 2 dermabrasion sessions saw a 20% reduction from the post-TCA score (P <.000001). The 5 patients who had 3 dermabrasion sessions saw a 40% reduction from the post-TCA score (P <.000012).

Limitations to this study include its small sample size. Future studies with more participants are warranted.

The majority (77%) of patients reported being satisfied with results from their TCA peel, and adverse events associated with the therapy included transient erythema “which is a possible complication of all peels” they researchers noted, and hyperpigmentation that resolved after 1 month of treatment with daily hydroquinone cream 4%.

The results of this study showed the researchers that a superficial TCA peel followed by manual dermasanding significantly reduces the appearance of acne scars. This method is inexpensive and can be used in place of more expense laser treatments, they acknowledged.


Al-Hamamy HR, AL-Dhalimi MA, Abtan AF. Evaluation of treatment of acne scars with 25% trichloroacetic acid chemical peel followed by manual dermasanding. [published online September 30, 2020]. J Cosmet Dermatol. doi:10.1111/jocd.13754