Given the advent of wider availability of skin biopsies and specific antibody testing, more objective data is available for evaluating patients with neuropathy. However, this information is often non-diagnostic and requires interpretation within appropriate clinical contexts.

Retrospective chart review of 156 patients with sensory neuropathy symptoms who underwent skin biopsy at Keck Medical Center of USC. Clinic notes, skin biopsy results, and antibody testing were reviewed.

Of the 156 patients reviewed, 109(70%) had abnormal epidermal nerve fiber densities compared to 47(30%) with normal biopsy results. Subjective sensory complaints were similar between both groups, 93.6% and 90.8% of patients, respectively. Objective sensory deficits were reported in 51.1% and 60.6% of patients, respectively. For individuals with prior nerve conduction studies, only 30% of the patients with abnormal biopsies and 25% of the patients with normal biopsies had evidence of large fiber neuropathy on electrodiagnostic testing. Of the 156 patients, 94 had sweat gland nerve fiber densities analyzed, and 84(89%) had abnormal findings. Of these, only 41(48%) had subjective autonomic complaints, compared to the 2 of 10(20%) patients who had autonomic complaints but normal sweat gland nerve fiber densities. In addition, 39 patients had an antibody sensory neuropathy panel performed; 21 of them had at least 1 positive antibody identified, most often FGFR3 and/or TS-HDS. Of these, 11(52%) had abnormal nerve conduction studies and 19(90.5%) had an abnormal biopsy.