BMJ  2007;334:1159-1162 (2 June), doi:10.1136/bmj.39192.488125.BE

Practice

Recent advances

Skin biopsy: a new tool for diagnosing peripheral neuropathy

Neuromuscular Diseases Unit, National Neurological Institute "Carlo Besta", 20133, Milan, Italy

The first 150 words of the full text of this article appear below.

Introduction

The prevalence of peripheral neuropathy is about 2% in the general population, but it rises to 12% and 17% in people with one or two recognised risk factors.¹ Diabetes is one such risk factor and the most common cause of this disorder—about half of patients who have had diabetes for 25 years have peripheral neuropathy. The early symptoms of diabetic neuropathy and other peripheral neuropathies are due to degeneration of small somatic nerve fibres, which may remain the only nerves involved.² However, "small fibre neuropathy" may not be detected by traditional physical, neurophysiological, and neuropathological tests. In the past decade, skin biopsy has become a popular method for investigating small nerve fibres.³ It allows general practitioners and non-specialists—such as diabetologists and specialists in orthopaedics—to diagnose neuropathy (thereby avoiding delayed or incorrect diagnosis), to investigate its aetiology, and to focus treatment, in particular for neuropathic pain.

Sources and selection criteria

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What are the clinical features of small fibre neuropathy?

What are the limitations of diagnostic tests for peripheral neuropathy?

What can skin biopsy show that other methods can't?

What are the other clinical uses of skin biopsy?

Demonstrating subclinical peripheral neuropathy
Demonstrating autonomic neuropathy
Monitoring neuropathy

How is a skin biopsy carried out?

Additional educational resources

How can I measure the density of intraepidermal nerve fibres?

What can you see in a skin biopsy?

Unmyelinated fibres
Myelinated fibres
Autonomic nerve fibres

What are the limitations of skin biopsy?

Summary points

Conclusion

Ongoing research

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