Pterin‐4a‐carbinolamine dehydratase (PCD) is an essential component of the phenylalanine hydroxylase (PAH) system, catalyzing the regeneration of the essential cofactor 6(R)‐L‐erythro‐5,6,7,8‐tetrahydrobiopterin [6(R)BH₄]. Mutations in PCD or its deactivation by hydrogen peroxide result in the generation of 7(R,S)BH₄, which is a potent inhibitor of PAH that has been implicated in primapterinuria, a variant form of phenylketonuria, and in the skin depigmentation disorder vitiligo. We have synthesized and separated the 7(R) and 7(S) diastereomers confirming their structure by NMR. Both 7(R)‐ and 7(S)BH₄ function as poor cofactors for PAH, whereas only 7(S)BH₄ acts as a potent competitive inhibitor vs. 6(R)BH₄ (K_i2.3–4.9 µM). Kinetic and binding studies, as well as characterization of the pterin‐enzyme complexes by fluorescence spectroscopy, revealed that the inhibitory effects of 7(R,S)BH₄ on PAH are in fact specifically based on 7(S)BH₄ binding. The molecular dynamics simulated structures of the pterin‐PAH complexes indicate that 7(S)BH₄ inhibition is due to its interaction with the polar region at the pterin binding site close to Ser‐251, whereas its low efficiency as cofactor is related to a suboptimal positioning toward the catalytic iron. 7(S)BH₄ is not an inhibitor for tyrosine hydroxylase (TH) in the physiological range, presumably due to the replacement of Ser‐251 by the corresponding Ala297. Taken together, our results identified structural determinants for the specific regulation of PAH and TH by 7(S)BH₄, which in turn aid in the understanding of primapterinuria and acute vitiligo. —Pey, A. L., Martinez, A., Charubala, R., Maitland, D. J., Teigen, K., Calvo, A., Pfleiderer, W., Wood, J. M., Schallreuter, K. U. Specific interaction of the diastereomers 7(R)‐ and 7(S)‐tetrahydrobiopterin with phenylalanine hydroxylase: implications for understanding primapterinuria and vitiligo FASEB J. 20, E1451–E1464 (2006)