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Melasma may be triggered by sun exposure, hormonal changes, cosmetic products that are irritating to the skin, stress, and thyroid disease

Diabetes Care 36 , 28032809 (2013)

This NAD+ elevation activates sirtuins, particularly SIRT1 in adipocytes and hepatocytes, which deacetylates and activates numerous metabolic regulatory proteins including PGC-1, a master regulator of mitochondrial biogenesis, oxidative metabolism, and thermogenesis

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