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The brightening on the deeper skin tones tends to go unnoticed later and require a longer period of time since the melanin activity is more prominent by nature

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A key practical limitation is the difficulty of maintaining long-term adherence to ketogenic interventions, which may reduce their feasibility and sustainability in dermatological practice

When the majority of that literature originates from a single research group, uses the same animal model, and has not been independently replicated, the effective evidence base is narrower than the publication count implies