Painful neuropathy states involving small peripheral nerve fibers are difficult to diagnose on clinical evaluation. Advances in immunohistochemical staining and use of confocal microscopy have led to the development of skin biopsy techniques for the evaluation of painful neuropathies. In this method, vertical sections of small skin biopsies are obtained and immunolabeled to show nerve endings. This technique provides no information about motor or large myelinated sensory fibers. The technique is minimally invasive and can be repeated to monitor progression of the disease.
KeywordsEpidermal nerve fibers Skin punch biopsy Immunohistochemistry Small fiber peripheral neuropathy PGP 9.5