Skin biopsy for the diagnosis of peripheral neuropathy

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Histopathology. 2008 Jul 15.

Skin biopsy for the diagnosis of peripheral neuropathy.

Lauria G, Lombardi R, Camozzi F, Devigili G.

Neuromuscular Diseases Unit, National Neurological Institute " Carlo

Besta " , Milan, Italy.

Skin biopsy has become an accepted tool for investigating small nerve

fibres, which are invisible to conventional neurophysiological tests

even though they are affected early on in peripheral neuropathies of

varying aetiology. Morphometric analysis of epidermal and dermal

nerves has proved to be reliable, reproducible and unaffected by the

severity of neuropathy, making skin biopsy useful for diagnosing

small fibre neuropathy (SFN) in clinical practice.

The possibility of obtaining skin biopsy specimens from different

sites of the body, to repeat them within the area of the same sensory

nerve, to distinguish between somatic and autonomic nerves and to

investigate the expression of nerve-related proteins has widened the

potential applications of this technique to clinical research.

Skin biopsy performed using a minimally invasive disposable punch is

a safe and painless procedure. Using specific antibodies with bright-

field immunohistochemistry or immunofluorescence technique, it is

possible to investigate unmyelinated fibres innervating the epidermis

of hairy and glabrous skin, large myelinated fibres supplying

specialized corpuscles in glabrous skin, and autonomic fibres

innervating sweat glands, blood vessels and arrector pilorum muscles.

This review discusses the features of skin innervation in hairy and

glabrous skin, the functional properties of skin nerve fibres and

their changes in peripheral neuropathies.