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The loading/maintenance pattern evolved from decades of underground use: early protocols (1990s) used higher doses with more side effects

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It reflects the point at which benzyl alcohol's antimicrobial efficacy drops below sterile threshold and peptide aggregates begin forming even at refrigerated temperatures

Dopamine stimulates desire while norepinephrine and oxytocin promote sexual arousal (3)

Treatments include off-label use of oral amitriptyline, doxycycline, gabapentin, pregabalin and serotonin and noradrenaline reuptake inhibitors

As long as the oral melanotic macule stays stable in size, shape, and color, no treatment is needed