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A small bit of the skin is removed from the affected area and tested to confirm the lesion as Melasma

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[24] Pagano G, Manfredi C, Pallard FV, Lyakhovich A, Tiano L, Trifuoggi M

Up-regulation of EGR-1 and cyclin D1 A bit more technical: EGR-1 (Early Growth Response 1) and cyclin D1 are transcription factors, proteins that, in the cells nucleus, determine which genes are switched on