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StatPearls Publishing, Treasure Island Antonelli A, Ferrari SM, Corrado A, Di Domenicantonio A, Fallahi P (2015) Autoimmune thyroid disorders

Poor prognostic factors for melasma treatment include: Fitzpatrick skin types IIIV genetic and familial predisposition long-standing disease 2 years persisting despite treatment history of procedural interventions (eg lasers, microneedling) history of treatment by 2 physicians (possibly suggesting long duration and recalcitrant disease) long-term self-treatment with topical steroids ochronosis from hydroquinone use either long term or high strength mixed-type melasma

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