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La evidencia sobre la utilidad de la terapia sistmica es limitada: los estudios son en su mayora de pequeo tamao, de reducida duracin, incluyen a mujeres de manera mayoritaria, la metodologa de evaluacin es heterognea y no hay parmetros consensuados de respuesta clnica relevante

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So in order to measure total bilirubin, the sample is treated with a suitable solubilizing agent (usually an alcohol)

For Fitzpatrick types IV to VI, the safest and most effective approach usually avoids aggressive IPL and instead combines Pico laser at conservative settings or microneedling with PDRN, gentle mandelic or low-glycolic peels, and prescription topical and oral brighteners, all under strict sun protection