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In some studies, combining azelaic acid with a retinoid (like tretinoin) or glycolic acid produced faster or greater lightening of melasma than azelaic acid alone

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96 Berberine has been proposed to affect hormone levels and insulin metabolism by inhibiting the PI3K/AKT and MAPK pathways, activating AMPK, and interacting with multiple other targets

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10 Environmental Exposures Epidemiologic studies and animal experimental models have identified an association between PD and the following environmental risk factors: rural residence, farming, well-water drinking, exposure to pesticides (including organochlorines, carbamates, paraquat, maneb, rotenone, and diethyldithiocarbamate), and long-term occupational exposure to copper, iron, lead, and manganese