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They are a frequent culprit of drug-induced phototoxicity, with doxycycline being the most commonly reported [6,19,21,42]

Becker LM, OConnell JT, Vo AP, Cain MP, Tampe D, Bizarro L, et al

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A borderline range of 200300 pg/mL may require further testing, such as MMA (methylmalonic acid) or homocysteine levels, to confirm deficiency and assess the need for supplementation or dietary changes.

This surge in cortisol enhances intestinal barrier permeability, ultimately resulting in intestinal leakage (Morais et al., 2021)

In the case of resistance, the guidelines recommend either switching to or adding a more potent agent with a nonoverlapping resistance profile