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However, for deep pigmentation, such as melasma or darker skin tones, it is rarely enough by itself

This has been attributed to increased mechanical fragility (iron deficient RBC are more rigid and more likely to fragment as they traverse through small capillaries under high shear), however oxidative injury to red blood cells is likely contributing to keratocyte formation (Yoo et al 2009) (given that antioxidant enzymes in red blood cells, such as glutathione peroxidase, contain iron)

For instance, medications like metformin can improve your body's insulin response, enabling better utilization of fatty acids for energy