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Research suggests that oral melatonin, at doses of 25 mg taken at night, can significantly reduce the Melasma Area Severity Index (MASI) score

Further supporting melatonins potential impact on brain insulin, a rat study demonstrated that melatonin, upon binding to its membrane-bound receptors, can initiate intracellular pathways in the brain typically activated by insulin binding to the insulin receptor (e.g., AKT serine phosphorylation) [137]

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Titration: There is generally no need for upward titration with B-complex vitamins as one might do with certain drugs, but if a patient is frail or known to react to injections, the provider may choose to start at a lower dose (for example 0.25-0.5 mL) and then increase to 1 mL as tolerated