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This makes it highly effective even when the root cause is hormonal imbalance, psychological stress, fatigue, or age-related decline

DOI: 10.1016/j.mce.2010.07.007 [13] Pfaus, J.G

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the latter is evaluated on the basis of the highest degree of cytological atypia present in more than a few melanocytes as low grade (nuclei 1.5 larger than basilar keratinocytes, with small or absent nucleoli and uniformly hyperchromatic or dispersed chromatin, and with random variation in size and shape) or high grade (nuclei larger than basilar keratinocytes, with prominent nucleoli and coarse or peripherally condensed chromatin, and with slightly confluent variation in size and shape) (62)

Bath-Hextall FJ, Matin RN, Wilkinson D, Leonardi-Bee J