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(180), treatment with oral estrogen (2 mg/d) and combined progesterone (10 mg/d) yielded reductions in AHI of 25 and 50%, respectively

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Additional topical options demonstrate varying mechanisms: Kojic acid 1-4%: Daily application with moderate tyrosinase inhibition Vitamin C serum 10-20%: Daily application with weak to moderate tyrosinase inhibition Tranexamic acid 2-5%: Twice daily application using anti-inflammatory mechanisms Systematic reviews document superior efficacy with combination therapy using oral plus topical glutathione versus monotherapy

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This imbalance leads to uncontrolled NE activity, subsequently causing early-onset emphysema (Stoller and Aboussouan, 2005)