Analysis of intraepidermal nerve fibers using skin biopsy is a recently developed technique, providing diagnosticinformation on small fiber neuropathies. The specimens are obtained by 3 mm punch biopsy, which is safe andminimally invasive. Immunohistochemical staining by Protein gene product (PGP) 9.5 demonstrate not onlyintraepidermal nerve fibers but dermal structures, such as sweat gland and erector papillae. Up to now, many studiesagree that intraepidermal nerve fiber density is dramatically reduced in various sensory neuropathies. The utility ofdensity measure was confirmed with high sensitivity in the diagnosis of sensory neuropathy, comparable to sural nervebiopsy or quantitative sensory testing. Besides quantitative methods, morphological changes like axonal swelling andfragmentation can be used as predegenerative markers. This article reviews the technique of skin biopsy and clinical andexperimental usefulness of skin biopsy in diagnosing and monitoring peripheral neuropathies.
