Skin Punch Biopsy conditions

Not all nerve pain shows up on standard nerve conduction studies. Small fiber neuropathy affects the smallest sensory nerve fibers responsible for pain and temperature sensation. Because routine nerve testing primarily evaluates larger fibers, small fiber damage can go undetected.

A skin punch biopsy allows us to measure intraepidermal nerve fiber density (IENFD) to determine whether small fiber nerve damage is present. This provides objective data that can validate symptoms and help move treatment planning forward with greater precision.

Our Approach to Small Fiber Neuropathy Evaluation

We use skin punch biopsy testing as part of a comprehensive diagnostic strategy. Our goal is not just to perform a test, but to clarify the underlying cause of neuropathic symptoms and guide next steps.

Our evaluation may include:

• Detailed symptom assessment and neurological examination
• Review of prior EMG and nerve conduction studies
• Blood work to assess for metabolic or autoimmune causes
• Identification of contributing conditions such as diabetes or inflammatory disorders
• Coordination with specialists when appropriate
  

If reduced nerve fiber density is identified, we use that information to refine treatment options and investigate potential underlying causes. If results are normal, that information is equally valuable in narrowing the diagnosis.

Conditions We Evaluate with Skin Punch Biopsy

Small fiber neuropathy testing may be appropriate in patients with suspected neuropathic pain associated with:

• Diabetes or prediabetes
• Idiopathic peripheral neuropathy
• Chronic neuropathic pain syndromes
• Complex Regional Pain Syndrome (CRPS)
• Fibromyalgia with neuropathic features
• Autoimmune or inflammatory conditions
• Hereditary neuropathies
• Unexplained burning, tingling, stabbing, or electric-like pain
• Persistent neuropathic symptoms with normal EMG results
  

Eligibility is based on clinical evaluation and symptom presentation.

What to Expect

The procedure is performed in-office using local anesthesia. A small skin sample is collected and sent to a specialized laboratory for nerve fiber analysis. The biopsy site is covered, and aftercare instructions are provided. The procedure is brief and typically well tolerated.

Our Goal

For patients living with unexplained nerve pain, small fiber neuropathy testing can provide measurable confirmation and direction. By identifying whether small nerve fiber damage is present, we can move from uncertainty to targeted, evidence-based care.

If you are experiencing persistent neuropathic symptoms, further evaluation may be appropriate.