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Ephelides (plural of ephelis) are usually found in fair-skinned individuals, are due to sunlight exposure, occur in childhood, tend to diminish with age, and are lighter in appearance
A rapid escalation is associated with low blood sugar levels and severe GI side effects such as severe abdominal pain, nausea, vomiting, and inflammation of the pancreas (pancreatitis)
10.3390/pharmaceutics17091190 Pharmaceutics 20 DelgadoJ.TerrnM.GarridoM.ParienteJ.BarrigaC.RodrguezA.et al (2013)
For other confirmed or suspected malabsorption, vitamin B12 replacement should be offered and intramuscular treatment should be considered instead of oral treatment
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