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Finally, some cosmetics, photosensitizing drugs (e.g., phenothiazines, sulfonamides, sulfonylureas, thiazide diuretics, tetracyclines, tricyclic antidepressants, promethazine, piroxicam), and steroid hormones (e.g., contraceptive pills, estrogen replacement therapies) increase the melanogenic effect of sun exposure and should be substituted to enable successful melasma treatment [24,25,26,27]

They could not explain it hence the development of the mushball theory

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