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Dermatology Specialists of Atlanta Neuropathy evaluation

medical illustration of peripheral neuropathy and nerve damageIt is estimated that 15-20 million people in the United States suffer from some form of peripheral neuropathy. The most common cause of neuropathy is small nerve fiber neuropathy, which involves small non myelinated or minimally myelinated nerves. Small fiber neuropathy occurs from damage to the small unmyelinated or minimally myelinated nerves, which may not repair effectively due to metabolic, immune or inflammatory dysregulation, or rarely to inherited defects.

Diabetes is the most common metabolic condition that predisposes to small fiber neuropathy, and may start when patients are pre-diabetic. However, a wide spectrum of autoimmune disorders including lupus erythematosus, auto-inflammatory disease such as fibromyalgia, infectious disorders such as HIV-1 disease, and medications may also predispose small fiber neuropathy. The diagnostic study of choice is evaluation of Epidermal Nerve Fiber Density (ENFD) in the skin.

Definitive diagnosis of peripheral neuropathy can be extremely helpful in determining which treatment options are best for a particular patient. Early detection such as in pre-diabetic patients can also be important since detection of reduced small nerve fiber density can predict the progression to a wide-spread neuropathy, and measure can be taken to prevent or delay this progression. ENFD testing can reduce the overall healthcare costs, unnecessary procedures or treatments and may improve patient care and quality of life. In addition, the identification of small fiber neuropathy can lead to recommendations for changes in life style and therapies that may have benefit for other associated health care issues.

Standard test for nerve damage such as electromyograms and nerve conduction studies are gross measures of large nerves, and they cannot give information on small sensory nerve fibers.

A simple 3 mm punch biopsy is taken in standardized areas for evaluation of small fiber neuropathy. This is done under local anesthesia and no suture is necessary with minimal post procedure care. If there is associated skin disease within the area this can also be evaluated at the same time.

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