Vitamin B6 is a complex of 6 vitamers: pyridoxal, pyridoxol, pyridoxamine, and their 5-phosphate esters. Due to its role as a cofactor in many enzymatic reactions, pyridoxal 5-phosphate (PLP) has been determined to be the biologically active form of vitamin B6. Vitamin B6 deficiency is a potential cause of burning mouth syndrome and a possible potentiating factor for carpal tunnel and tarsal tunnel syndromes. Persons who present with chronic, progressive nerve compression disorders may be deficient in vitamin B6 and should be evaluated. Vitamin B6 deficiency is associated with symptoms of scaling of the skin, severe gingivitis, irritability, weakness, depression, dizziness, peripheral neuropathy, and seizures. In the pediatric population, deficiencies have been characterized by diarrhea, anemia, and seizures. Markedly elevated PLP in conjunction with low levels of pyridoxic acid are observed in cases of hypophosphatasia, a disorder characterized by low levels of alkaline phosphatase and a range of skeletal abnormalities.