Assessment of Epidermal Nerve Fibers: A New Diagnostic and Predictive Tool for P

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J Neuropathol Exp Neurol. 2007 Dec;66(12):1059-73.

Assessment of Epidermal Nerve Fibers: A New Diagnostic and

Predictive Tool for Peripheral Neuropathies.

Ebenezer GJ, Hauer P, Gibbons C, McArthur JC, Polydefkis M.

From the Department of Neurology (GJE, PH, MP), s Hopkins

University, Baltimore, land; Department of Neurology (CG), Beth

Israel Deaconess Medical Center, Harvard Medical School, Boston, MA;

and Departments of Neurology, Pathology and Epidemiology (JCM),

s Hopkins University, Baltimore, land.

Today, skin biopsies can play an important role in the diagnosis of

peripheral nerve disorders and have yielded another diagnostic tool

for the neurologist. One of the commonly reported neuropathologic

abnormalities observed in skin biopsies is a reduction of epidermal

nerve density. Analyzing the changes in the morphology and density

of epidermal nerves is of immense diagnostic and prognostic value in

peripheral neuropathies.

These changes also provide an assessment of disease progression and

of tissue responses to regenerative treatments. Combined with

immunohistochemical studies, newly evolved skin biopsy and epidermal

count techniques have the potential to provide significant

information about the pathogenesis of many peripheral nervous system

diseases. They have great potential for impacts on both research and

clinical approaches to treatment.

Evolution of a standardized and validated counting methodology and

significant advances in procuring skin biopsies have opened up a

wide spectrum of applications that make the technology easy to apply

in practice. The application of this technology may lead to early

detection of many common peripheral nerve diseases and an enhanced

understanding of disease onset and progression. In this article we

review the state of current research and clinical practice in the

use of skin biopsies and epidermal nerve densities.