NOVADX SKIN TEST FOR SMALL FIBER NEUROPATHY  (ENFD)

WHO WE ARE & WHAT WE DO

 NovaDX is a leading histopathology lab designed to assist our physicians and patients in diagnosing small nerve peripheral neuropathy. Located in Templeton, California, NovaDX offers a national lab to better assist providers in specimen referral and turnaround times. At NovaDX it is our goal is to facilitate in faster reporting times and better outcomes for patients. Our services can reduce overall healthcare costs, unnecessary surgeries and treatments, and improve patient care.

SKIN BIOPSY PROCEDURE

  • The skin test is brief, simple, and effective.

  • The skin is numbed with an anesthetic after which a 3mm punch is used to remove a biopsy from the patient.

  • The site is generally covered with a bandage.

  • This test takes roughly 5 minutes from start to finish.

SERVICES PROVIDED

  • Kits and shipping

  • In-office and staff training for biopsy removal, packaging, and shipment

  • Expert staff and board certified pathologists available for consultation

  • Direct billing to patient insurance plans

WHAT IS ENFD TESTING?

ENFD testing or Epidermal Nerve Fiber Density Testing can help diagnose small fiber neuropathy, also known as small-fiber sensory/peripheral neuropathy. It 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.

WHY TEST?

Epidermal Nerve Fiber Density (ENFD) testing can help diagnose small fiber neuropathy, also known as peripheral neuropathy. It is a peripheral nerve disease that selectively affects small diameter nerve fibers. These fibers innervate the skin, aid in temperature perception, pain, and autonomic regulation. ENFD testing can aid in the process of finding a unifying diagnosis.

WHO QUALIFIES?

Patients suffering from pre-diabetes, diabetes, fibromyalgia, auto-immune disorders or other metabolic syndromes should be tested for SFPN. Additionally, patients can be tested if dealing with pain, numbness or tingling, abnormalities in blood pressure, or loss of coordination or balance qualify for this test. At NovaDX, we offer proper documentation in order to screen for who qualifies for the punch biopsy.

HOW IS THE TEST PERFORMED?

Punch biopsies taken for epidermal nerve fiber density testing are taken in a manner similar to those obtained to assess other conditions of skin. There are four important points to remember when obtaining a biopsy 1) biopsies must be performed at one of a few specific anatomic locations, 2) as a standard, 3mm punch biopsies are used, 3) special care must be taken not to crush or distort the surface epithelium, 4) the biopsy is NOT fixed in formalin.

AFTER DIAGNOSIS, WHAT’S NEXT?

There are many options available for treating Small Fiber Neuropathy. The most effective ones address the underlying cause. Most often, the focus of treatment is on symptom control. If the cause is diabetes, pre- diabetes, or metabolic syndrome, papers have shown the symptoms improve by treating the insulin resistance, deconditioning and vitamin deficiencies. Literature suggests that patients can be helped by physical therapy, well balanced diets, avoiding exposure to toxins, exercise, vitamin supplements, limiting or avoiding alcohol, prescription drugs or other complementary and integrative therapy

Common causes of small nerve peripheral neuropathy:

  • Celiac disease

  • Endocrine and metabolic disorders

  • Fabry disease

  • Guillain-Barre syndrome

  • Hepatitis C

  • Hereditary amyloidosis

  • Hereditary diseases

  • HIV

  • Hypothyroidism immune system disorders

  • Infectious diseases

  • Inflammatory bowel disease

CITED  BENEFITS:

  • 88.4 % sensitivity detection compared to 56.4% for standard clinical exams.

  • Neuropathy discovery not easily detected through electrophysiology

  • Early detection of nerve fiber damage even in asymptomatic patients.

  • Evaluation of disease progression

  • Convenient way to identify and monitor small fiber neuropathies

  • Reduction in long term opioid addictions

  • Lupus

  • Lyme disease

  • Metabolic syndrome

  • Mixed connective tissue disease

  • Psoriasis

  • Rheumatoid arthritis

  • Sarcoidosis

  • scleroderma

  • Sjogren’s syndrome

  • Tangier disease

  • Vasculitis