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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

Determinants of efficacy and safety in epicutaneous allergen immunotherapy: summary of three clinical trials

Comparative efficacy and safety of urate-lowering therapy for the treatment of hyperuricemia: a systematic review and network meta-analysis

For weight loss, it may take a few weeks, as results are more gradual

Urolithiasis 43(Suppl):1109123

Structured physical therapy Critical for organizing collagen properly BPC-157 accelerates healing