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Because the skin in exposed areas of the head and neck is very thin in older patients, a penetration depth of 1.1mm is sufficient to reach a considerable portion of the dermis.91 The disadvantages of radiation therapy are the limited penetration of x-rays (which explains why the Miescher technique can fail in cases where melanocytes extend below the adnexal structures91), the need for multiple sessions (generally done only in urban areas with adequate infrastructure93), and the difficulty of detecting recurrence due to treatment-induced pigmentary changes

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Notably, Trulicity carries a higher risk of low blood sugar (hypoglycemia) when used with insulin or sulfonylureas (up to 20%), while Zepbound shows lower hypoglycemia rates (~5%)