Chung Hye Jin, Al Janahi Sara, Cho Sung Bin, Chang Yunyoung Claire
Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Department of Dermatology, Boston University School of Medicine, Boston, MA, USA.
J Cosmet Dermatol. 2021 Jan;20(1):18-27. doi: 10.1111/jocd.13556. Epub 2020 Jul 8.
Chemical reconstruction of skin scars (CROSS) applies a high strength acid focally to treat atrophic scars. Although this method has gained popularity over the past two decades, no standardized treatment guideline exists for CROSS method in the treatment of atrophic scars.
The purpose of this comprehensive review was to evaluate the indications, detailed techniques, efficacy, and safety of CROSS method.
An extensive literature review was conducted to identify articles relating to CROSS method for atrophic scars from 2002 to 2018.
The literature search yielded 19 articles meeting criteria. CROSS method has been used for the treatment of acne scars, varicella scars, enlarged pores, and depressed surgical scars. In studies using the quantile grading scale for acne scars, 60%-100% of patients showed >25% improvement. In two studies for varicella scars, 83%-100% of patients showed >25% improvement. CROSS method seems to be effective specifically for ice-pick scars. It is well tolerated and safe in Fitzpatrick skin phototypes I-V. Most reported complications are temporary and include postinflammatory dyspigmentation, erythema, pain, pruritus, infection, and widening of scars.
This literature review suggests that CROSS method is a safe and effective treatment for atrophic scars, especially ice-pick scars, in skin types I-V. However, current published works have several limitations, including small sample sizes, lack of control group, different concentrations of acid, different frequency of treatments, and follow-up periods. Larger, randomized, controlled studies are needed to elucidate the optimal treatment protocol of CROSS method.
皮肤瘢痕化学重建术（CROSS）通过局部应用高浓度酸来治疗萎缩性瘢痕。尽管该方法在过去二十年中已得到广泛应用，但在萎缩性瘢痕治疗中尚无针对CROSS方法的标准化治疗指南。
本综述的目的是评估CROSS方法的适应症、详细技术、疗效和安全性。
进行了广泛的文献检索，以确定2002年至2018年期间与CROSS方法治疗萎缩性瘢痕相关的文章。
文献检索得到19篇符合标准的文章。CROSS方法已用于治疗痤疮瘢痕、水痘瘢痕、毛孔粗大和凹陷性手术瘢痕。在使用痤疮瘢痕分位数分级量表的研究中，60%-100%的患者改善超过25%。在两项关于水痘瘢痕的研究中，83%-100%的患者改善超过25%。CROSS方法似乎对冰锥样瘢痕特别有效。在Fitzpatrick皮肤光型I-V中耐受性良好且安全。大多数报告的并发症是暂时性的，包括炎症后色素沉着、红斑、疼痛、瘙痒、感染和瘢痕增宽。
本综述表明，CROSS方法是治疗I-V型皮肤萎缩性瘢痕，尤其是冰锥样瘢痕的一种安全有效的方法。然而，目前已发表的研究有几个局限性，包括样本量小、缺乏对照组、酸浓度不同、治疗频率不同和随访期不同。需要进行更大规模的随机对照研究，以阐明CROSS方法的最佳治疗方案。
