Only recently, epidermal nerve fibers (ENF) were extensively investigated taking advantage of the immunoreactivity against protein gene product (PGP) 9.5, a cytosolic ubiquitin carboxyl-terminal hydrolase. Anti-PGP 9.5 has proved to effectively mark all nerve fibers, including nerve endings within the epidermis. ENF density is a useful and reliable parameter which is even more sensitive than sural nerve morphometry in diagnosing small fiber neuropathy. Skin biopsies, performed after local anesthesia, are painless and leave a scar scarcely noticeable over time. This method has been used in acquired sensory neuropathies (diabetic neuropathy, post-herpetic neuropathy, Ross syndrome), idiopathic painful neuropathies and hereditary neuropathies (Fabry disease, Friedreich ataxia, congenital insensitivity to pain with anhidrosis). Besides the evaluation of small fibers, skin biopsy can be used to study large myelinated fibers and cutaneous mechanoreceptors. In fact, Meissner corpuscles and their afferent nerve fibers can be primarily affected in dying back neuropathy but can not be explored with the common electrophysiological and morphological methods in an early stage of disease. The possibility of repeating skin biopsy over time allows also experimental applications. In fact, this method has been used to study the neurodegenerative effect of topical application of capsaicin in human and to monitor the regeneration of nerve fibers once capsaicin application was interrupted.
|Issue number||4 SUPPL.|
|Publication status||Published - 2000|
ASJC Scopus subject areas
- Clinical Neurology