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Tretinoin requires patience — most users experience an initial “purge” phase (4–6 weeks of worse-looking skin as deeper congestion surfaces), followed by clearer skin starting around weeks 8–12, with broader anti-aging results visible at 4–6 months

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Other mechanisms include increased insulin resistance induced by high-dose glucocorticoids that increases intra-portal insulin, decreases IGFBP-1 that increases free IGF-I, and direct glucocorticoid effects in increasing hepatic IGF-I synthesis and decreasing hepatic insulin clearance (105)