Epidermal Nerve Fiber Density (ENFD) testing is the analysis of a 3mm punch biopsy of skin to quantify the number of unmyelinated C-fibers and myelinated A delta-fibers within the epidermis.
The skin has a rather consistent number of epidermal nerves at specific anatomical sites. This density is also found to be consistent between different age groups and genders. Small fiber peripheral neuropathy is indicated when this density runs below the normal curve. Also, prior to the onset of symptoms, degeneration within the epidermal nerves may predict peripheral neuropathy.
ENFD is not new technology actually; neurologists have used this technique for over 15 years. Peripheral neuropathy begins with the body’s smallest and most distal nerves, which are the C-fibers and A delta-fibers, and then progresses proximally in a stocking-like distribution.
Some most common causes of small fiber peripheral neuropathy include:
- Diabetes mellitus, Type I and II
- Metabolic syndrome
- Idiopathic/familial
- Alcohol abuse
- Human Immunodeficiency Virus
- Amyloidosis
- Pharmacologic toxins (metronidazole)
- Solvent exposure
- Chemotherapy-induced
- Leprosy
- Vasculitis
- Autoimmune (various disorders)
Advantages of ENFD
- Purely objective measure of small nerve disease
- Possibly might be able to predict neuropathy
- Easily performed in an office setting
- Provides a baseline so that the benefits of therapeutic agents may be measured
- Highly specific and sensitive
- Quick and easy to perform
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