A simple melasma skincare routine is as follows: AM: Ascorbic acid- vitamin C, SPF, polypodium 480 mg, vitamin C tablet orally Midday: Sunscreen reapplication, lotion, stick or spray, polypodium 480 mg PM: 20% Azelaic acid, melatonin 3-5 mg taken nightly, option for glutathione tablets The combination of choice will be determined by our dermatologist at The Melasma Clinic

While often temporary, this increase in platelets carries serious risks: Deep vein thrombosis (blood clots in deep veins, usually in legs) Pulmonary embolism (blood clots in lungs) Arterial thrombosis (clots in arteries) Cerebrovascular events (strokes) Coronary artery thrombosis (heart attacks) Splanchnic vein thrombosis (clots in abdominal veins) The risk is particularly high in: Elderly patients Those with pre-existing heart disease Patients with inherited blood-clotting disorders Immobilized individuals Those with hardened arteries Neurological Symptoms and Joint Pain Paradoxically, B12 replacement can temporarily worsen or trigger new neurological symptoms
TRIF/TRAM, TRIF (TLR4 signaling)-related adapter molecule (TRAM)
Hernandez AF et al
see pairing copper peptides with niacinamide for the actual evidence
long-term safety and efficacy in humans have not been fully established