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While a link to the Internal Medicine Review is provided, the source does not contain the cited systematic review, though proponents argue the Shoemaker Protocol is one of the few treatment frameworks for unexplained multi-symptom illnesses with documented clinical efficacy across multiple peer-reviewed papers

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Factors such as friction, shaving, sweat buildup, dead skin cells, deodorant residue, hormonal changes, and sun exposure can contribute to underarm pigmentation over time

The studies found that 82% of patients ultimately had an IOP 18mm Hg, 30.9% achieved at least a 40% reduction over baseline and 60% achieved a 30% reduction in IOP