The mechanism is not fully established but may relate to metabolic shifts from rapid fat mobilization, which can transiently stress hepatic processing
British Journal of Dermatology
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Andersson M, Gunne H, Agerberth B, Boman A, Bergman T, Sillard R, Jrnvall H, Mutt V, Olsson B, Wigzell H, Dagerlind A, Boman HG, Gudmundsson GH: NK-lysin, a novel effector peptide of cytotoxic T and NK cells
The third pathway involves a non-oxidative pathway catalyzed by fatty acid ethyl ester (FAEE) synthase