TCA CROSS for Acne Scars: How This Treatment Works

If you’ve been with me for a while, you know that getting acne under control is always our first priority at Skin+. But once we’ve cleared the breakouts, we can finally start addressing what the acne left behind.

And sometimes, that means dealing with those deep little holes in the skin that just won't go away.

You know the ones I’m talking about. Those tiny, deep scars that almost look like someone poked the skin with a needle.

These are called ice pick acne scars, and they can be some of the most difficult types of acne scars to improve.

That’s where TCA CROSS comes in.

I'm excited about this treatment because it allows us to target individual scars that may not respond as well to other acne scar treatments.

Let's talk about how it works, who it's for, and why treating acne scars requires understanding exactly what type of scarring we're dealing with.

Microneedling for Acne Scars: The Next Step After Clear Skin

If you’ve spent months getting your acne under control, clearing the breakouts is only part of the story.

Once active acne settles, many people are left with the things acne leaves behind: indented scars, uneven texture, enlarged-looking pores, dark spots, and areas where the skin no longer feels as smooth as it once did.

That is exactly why I’m so excited to bring professional microneedling to Skin+.

Microneedling, also called collagen induction therapy, is a minimally invasive procedure that uses tiny needles to create controlled microscopic punctures in the skin. These tiny punctures activate the body’s natural healing process, encouraging collagen production, elastin production, and skin regeneration.

For acne-prone skin, that matters.

As the skin creates new collagen, it can gradually remodel damaged scar tissue, improve the appearance of acne scars, and create smoother skin and healthier skin over time.

And if you know me, you know I didn’t want to bring in a treatment just because it was popular.

I wanted something that fits the way we already treat skin at Skin+: with a plan, with intention, and with results as the goal.

3 Must-Have Products for Inflamed Acne That Won’t Quit

If you walked into my acne clinic with red, angry, inflamed breakouts and asked me, “What are the three products I absolutely need?” I would make this pretty simple.

For inflamed acne, my three must-haves are:

1. Acne Gel with benzoyl peroxide

2. CytoClear Mandelic Acid 3-in-1 Serum

3. HylaVera Gel Moisturizer

Those are the three acne products I reach for over and over again when I am working with inflamed, red, sometimes painful acne-prone skin.

And if you already have a full skincare routine and don’t want to throw everything away? You don’t necessarily need to.

Make sure your face wash, moisturizer and sunscreen are free of ingredients that could be contributing to clogged pores. Then look at the treatment portion of your routine.

If someone asked me, “What can I add to or replace in my current routine to better target inflammatory acne?” these are the three products I would start with.

Before we get into them, let’s talk about why.

Why Is My Pimple Itchy? What That One Bump Means

I hear this question in the treatment room almost every week: "Why is my pimple itchy?" Someone points to one spot, usually on their chin, their back, or the outside of an upper arm, and says it doesn’t look like their usual breakouts. It’s not painful exactly. It’s just itchy. And that one small detail is often more useful for figuring out what’s really going on than almost anything else about the bump.

Here’s something I tell my clients constantly: not every itchy bump is acne, and itchy acne is not automatically a red flag on its own. Itching is actually a normal symptom of acne. In one study of acne patients, close to 40% reported itching as one of their acne symptoms, and itch intensity didn’t even track with how severe the acne breakouts looked. So if your skin has ever itched during a flare, you’re not imagining it, and you’re not alone.

Still, “it’s probably fine” isn’t a diagnosis. Finding the underlying cause is the first step to treating it correctly, because acne, fungal acne, keratosis pilaris, and a straightforward skin reaction are different types of acne, and non-acne skin bumps, that each call for a different plan. Once you know the type of acne, or the non-acne condition, you’re actually dealing with, the right next step gets a lot clearer. Treating the wrong one can leave you more irritated than when you started.

I’ve told the story before about my own years of struggling with back acne, and looking back, some of those bumps itched long before they ever surfaced as visible pimples. That’s part of why I don’t dismiss itching as “nothing.” It’s information, and it’s worth paying attention to.

Can Drool Cause Acne Around Your Mouth and Chin?

If you keep breaking out around your mouth and chin, I want you to think about something most people never consider:

What touches that exact area of your face every single day?

Your toothpaste. Your lip balm. Your food. Your pillow. Your phone.

And yes, your drool.

I know. Not glamorous.

But when we’re trying to figure out stubborn acne, sometimes the weird little daily habits are exactly where I start looking.

I’ve treated acne for years, and one thing I’ve learned is that acne treatment can turn into detective work. If someone has frequent breakouts in one very specific area, I want to know what repeatedly touches that skin before I start adding more skincare products or stronger active ingredients.

So, can drooling really cause acne around your mouth?

Not exactly on its own. But it can definitely be one of the factors that keeps an acne-prone area irritated and harder to clear.

Why Your Acne Keeps Coming Back in the Same Spot

You know that pimple.

It shows up on your chin. You finally get it to go away. Your skin looks good for a week or two and you think, Finally. Bye bye blemish.

Then suddenly...it's back.

In. The. Exact. Same. Spot.

I hear this all the time in the clinic: “Carly, why does my acne keep coming back right here?”

And I completely understand why it feels like the same pimple has somehow been resurrected from the dead.

But there is usually much more happening underneath the surface of your skin than you can see in the mirror.

Acne starts inside the pore—more specifically, inside the hair follicle. By the time you see a red bump sitting on the surface of the skin, that follicle has already been going through a process involving oil, dead skin cells, inflammation and bacteria.

So if your acne keeps returning to the same area, treating the pimple you can see isn't always enough.

We have to think about what is happening underneath it.