Small-fiber neuropathy, also known as small-fiber sensory/peripheral neuropathy, is a peripheral nerve disease that selectively affects small diameter nerve fibers. These fibers innervate the skin, and aid in temperature perception, nociception (pain), and autonomic regulation. Common symptoms with peripheral neuropathy include:

  • Pain

  • Numbness

  • Pins and needles

  • Burning

  • Electric shock

  • Restless leg syndrome

  • Tingling

  • Reduced pain

  • Temperature perception

  • Autonomic dysfunction

Skin Biopsy to Diagnose Small Fiber Neuropathy

Performing a skin biopsy to analyze and quantify nerve fibers in the epidermis is a relatively simple and convenient way to identify and monitor small fiber neuropathies. Studies support the high sensitivity and the specificity city of skin biopsy in detecting small nerve fiber loss and it has been used not only in diagnosis, but also to evaluate disease progression and treatment success. ENFD studies have been found to have 88.4% sensitivity in detection, compared with 54.6% for clinical exams alone. Moreover, the test can detect early nerve fiber damage even in asymptomatic patients.

What can skin biopsies detect?

  • Abnormal epidermal nerve fiber innervation

  • Severity of neuropathy at sites not easily tested through electrophysiology

  • Abnormal nerve fiber morphology which can predict development of neuropathy

  • A pathological alternative in settings where electrophysiology is not available.

  • Distinguish neuropathy from other causes of pain.