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CDC is initiated by binding of C1q, leading to the activation of downstream complement proteins and resulting in assembly of the membrane attack complex (MAC)

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Their role may be most relevant when inflammatory skin disease and metabolic disease coexist, but larger controlled studies are needed

After reviewing literature and conducting a two-round Delphi survey with 42 experts, a consensus emerged that emphasizes prioritizing clinical symptoms in diagnosis, with serum B12 as a screening marker supported by methylmalonic acid or homocysteine levels for additional confirmation