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The transcription factor p53 also plays a dual role in melanocyte defense by upregulating tyrosinase, a key enzyme in melanogenesis, and enhancing the antioxidant response via the Nrf2 pathway 17 , but also it can stop the melanocyte cell cycle, even leading to apoptosis 79

Additionally, future studies should include larger patient populations, a broader range of liver pathologies, and diverse ethnic groups to ensure more generalizable findings and to account for potential variations in treatment response based on these factors

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These changes are tightly linked to mechanisms including chronic low-grade inflammation, progressive insulin resistance, mitochondrial dysfunction, and alterations in adipocyte structure that become more pronounced with menopause and the gradual loss of muscle mass (Ross et al., 2002)