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Do not interpret photographic improvement as proof of mechanism in your own case

The mechanisms are poorly understood but may involve modulation of neurotransmitter systems (dopaminergic, serotonergic), reduction of neuroinflammation, and protection against excitotoxicity

This article focuses specifically on the topical serum format

In the meantime, the stimulus-response coupling is often mediated by complex intra- and extracellular communications and feedback regulations within networks of signaling pathways and pharmacological systems, including neuroendocrine-immune complex, cardiovascular, gastrointestinal, and other systems

The trial-product estimand is closer to as-treated: it estimates the effect if participants stayed on treatment as intended