Recent developments in the management of peripheral neuropathy using skin biopsy

Skin biopsy has become widely used to assess small calibre nerve fibres in peripheral neuropathies. The technique is safe, minimally invasive, painless, easy to perform and cheap. It provides diagnostic information in patients with small fibre neuropathy in whom routine neurophysiological tests are commonly normal. Moreover, it allows investigation of the innervation of sweat glands, thus giving information about the autonomic nervous system as well. Biopsy of the hairy skin is used to investigate unmyelinated and small myelinated fibres, whereas biopsy of glabrous skin is used to examine large myelinated fibres. The applications of skin biopsy for diagnostic and research purposes cover the spectrum of peripheral nervous system diseases, from painful axonal neuropathies to sensory neuronopathies and immune- mediated and inherited demyelinating neuropathies. Finally, studies on axon regeneration in humans and in experimental models suggest that skin biopsy is potential useful for monitoring the progression of neuropathies and efficacy of their treatment.

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