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83 Hyperglycemia upregulates the expression of mesenchymal markers, such as -SMA and fibronectin, while downregulating the expression of endothelial markers, such as CD31
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Prescribers can adjust hydroquinone beyond the commercial 4% ceiling (up to 8% for refractory cases), swap the steroid component based on patient sensitivity, add tranexamic acid or cysteamine for resistant pigmentation, and choose vehicle bases optimized for different skin types and climates
