What is Epidermal Nerve Fiber Density (ENFD) testing

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.

Epidermal Nerve Fiber

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

For an appointment with one of our doctors at one of our nine Southern California locations please call 310-828-0011 or visit us at www.footankleinstitute.com

One comment

  1. I’ve been searching all over the place for more info on ENFD and came across your article.
    What a perfect web-site.

    Thanks for sharing superb information. Your web site is so cool. I’m impressed by the details that you have on this site. I bookmarked it, I will be back.

Leave a Reply

Your email address will not be published.

15,966 Total 1st Party Reviews / 4.9 out of 5 Stars
  • Yelp
    I highly recommend Dr. Baravarian at UFAI.  After months dealing with another doctor and getting no results (and a really painf...
    Mari W.
  • GatherUp
    From office staff was not reliable in communicating me needs.
    Lee S.
  • Yelp
    I am a huge fan of Dr. Bob. I play soccer for fun and have had my fair share of visits to his office. Each time he has been ver...
    Shahrad T.
  • GatherUp
    Dr. Briskin is great. Very personable and connects with patient. Definitely feel you are in good hands with knowledgeable and c...
    Jack R.
  • GatherUp
    Excellent group of people to interact with as my foot was assessed.
    Rebecca C.
  • Yelp
    Amazing all around what a profession doctor and staff thanks Dr. Baravarian and your team!!!!
    Danny H.
  • GatherUp
    Dr. Briskin and his fellow (I can't remember her name) did an amazing job! I highly recommend both of them!!!
    Adam D.
  • GatherUp
    Great
    Herman C.
  • GatherUp
    Great
    Mary F.
  • GatherUp
    I had a great experience and Dr. Kelman is the best!!
    Susan F.
  • GatherUp
    I waisted a trip to the office for pick up. The girl who initially helped me insisted to sell me a pair larger than my size. I ...
    Caroline H.
  • GatherUp
    I came in with pain on my L foot. I was seen on time and the staff where very friendly. I was diagnosed with a Taylor’s Bunion ...
    Joan A.
Same Day Appointments
Now Available!

Or call 877-989-9110

24 hours a day, 7 days a week