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Moreover, UV radiation can activate the proopiomelanocortin (POMC) gene and thereby enhance the production of alpha-melanocyte stimulating hormone (-MSH) and adrenocorticotropic hormone (ACTH) which can lead to increased PKA and melanogenesis (Im et al., 2002)

A subset of patients (about 15 to 20%) discontinue due to side effects, mostly mood changes, paresthesia, or insomnia