Why a Skin Biopsy?

Your physician may recommend performing a skin biopsy to help find out if you have peripheral neuropathy. The skin is stained by an antibody to a nerve marker, and the number, or density, of the nerve fibers is then counted. A reduction in the epidermal nerve fiber density is diagnostic of neuropathy. 

When is the test useful?

The test is particularly useful in patients with symptoms or signs of neuropathy, but with normal EMG and nerve conduction studies.  This often occurs when the neuropathy preferentially affects the small nerve fibers, as these are not picked up in the electro-diagnostic studies.  Although more sensitive, the test is not full proof, so that a normal test does not necessarily rule out the presence of neuropathy. 

What if you have small fiber neuropathy?

If the skin biopsy reveals that you have small fiber neuropathy, additional tests may then be ordered for possible causes. These include diabetes, glucose intolerance, nutritional deficiencies, autoimmune diseases such a Sjogren’s syndrome or lupus, Lyme disease, and toxins or drugs, among others. Therapy consists of both treating the underlying cause, and relieving the symptoms.    

How is the test performed?

The skin specimens are obtained by a punch biopsy, under local anesthesia. Two specimens, approximately 3 mm in diameter and 2 mm deep, are routinely taken at the thigh and above the ankle. Both sites are tested as the neuropathy can occur in a spotty distribution. The biopsy site should be kept dry for about 3 days, and is covered by a band aid to keep it clean and protect it. It should become completely healed in 7 to 10 days.

Potential Complications

The biopsy procedure is generally safe, and there is little discomfort. The only complications, which rarely occur, include excessive bleeding or infection. These can be controlled by local pressure or antibiotics.  If either occurs, contact your physician.  

Reporting the Results

After performing the test, Therapath will send a report to your physician, who will then notify you of the results and discuss them with you.

Insurance Coverage

Therapath will directly bill your insurance carrier, who is expected to cover the cost of the test. You may receive a call from a member of our staff to confirm your insurance information.

Can I recieve a copy of my test results?

As you may know, the Data Privacy Rule under HIPAA (Health Insurance Portability and Accountability Act) allows patients to request access to their medical information.  At the same time, however, laws in some states prohibit clinical laboratories from releasing laboratory test results directly to patients.  The Clinical Laboratory Improvement Amendments (CLIA) require that ACS follow state law and, where state law is more strict than HIPAA, ACS is not permitted to release your test results to you.  If your healthcare provider ordered your test for you, please contact your healthcare provider to obtain copies of your test results.