The terminal endings of small nerve fibers in the epidermis are often the first areas to degenerate, with distal to proximal gradients.
Small fiber neuropathy may involve single nerves (mononeuropathy) or many nerves (polyneuropathy), often in a length dependent fashion.
Cutaneous nerve evaluation has been used clinically since 1993 and is well tolerated by patients. It is a sensitive, site directed, repeatable technique that reveals both acute and chronic forms of sensory neuropathy.
Control data for adults are available at the distal leg, distal and proximal thigh regions.
This test is easily performed in a physician's office or clinic with resultant biopsies being sent to the University of Utah for processing.
Providers must be careful to not crush the biopsy when removing it from the patient.
Skin Biopsy Results
The biopsies are sectioned and stained with anti-PGP9.5 antibody, a neuronal specific marker. This antibody allows the reading physician to analyze the intra-epidermal sensory nerves.
Clinical diagnosis is based on the density of these nerves and a report is generated and sent to the referring physician.