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Any correction protocol that exfoliates and treats without restoring the barrier leaves the tissue exposed to exactly the kind of environmental aggression that triggered the pigmentation in the first place

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The deletion of ATF4, an upstream factor of ChaC1, in embryonic fibroblasts, results in a ferric oxide-dependent death phenotype, emphasizing the role of ATF4 as a downstream molecule of the eIF2/ATF4 pathway (117)