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The expanding syrinx initially compresses the anterior white commissure , disrupting the decussating fibers of the spinothalamic tract and causing bilateral loss of pain and temperature sensation in the upper extremities

Tri-Luma cream containing hydroquinone 4%, tretinoin 0.05%, and fluocinolone acetonide 0.1% has been authorized by the FDA for melasma management and should be applied once daily on the affected facial areas for at least 8 weeks (Ferreira Cestari et al., 2007

The increase in uric acid leads to gout In general, mycotoxins, which damage the kidneys and, therefore, impact the renal excretion of uric acid, are potentially a factor for gout appearance

doi: 10.1038/srep14174

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PMID: 37816395