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Its a hormonal one

Most people see gradual changes: a subtle glow within ~2 weeks, more even texture by 34 weeks, fading of dark spots over 13 months, and clearer brightening by 36 months in those who respond

Ann Thorac Surg 101(1):211-7, 2016

The contribution of caspase-8 and caspase-3, activated downstream of the Fas/Fas-associated death domain (FADD) signaling, to the promotion of PS externalization was shown in 2005 [136]

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Furthermore, it is essential to elucidate the specific pathways of cross-organ migration of oral microbiota, their colonization conditions, and the regulatory details of their influence on gut-brain axis signaling, including immune factors, metabolites, and neurotransmitters