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14 Nitrous oxide inhibits methionine synthetase, which can lead to disruption of fatty-acid metabolism required for myelination and synthesis of cellular plasma membranes

In this article, we will explore some of the various theories that are currently in circulation, which outline the cause as: Excessive production of porphyrin by skin bacteria stimulated by B12 A cobalt allergy Relative deficiency of vitamin B12 cofactors A detoxification reaction Vitamin B12 Acne The Work of Skin Bacteria

But, cyanocobalamin is often chosen because its stable and cheaper

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The cell can become distorted and unstable if it doesn't get enough of the vitamin