Small Fiber Neuropathy is dysfunction and degeneration of the small unmyelinated C fibers and the thinly myelinated A-delta fibers.  Symptoms usually begin in the foot or leg but can spread. Patients typically describe a burning or shooting pain.

Sudomotor testing is used in the clinical setting to evaluate and document neuropathic disturbances that may be associated with pain. Sudomotor testing is also the only way to detect isolated damage to sudomotor nerves in several different disease states such as Ross Syndrome, Harlequin Syndrome, diabetes, multiple system atrophy, Parkinson’s disease, autoimmune autonomic ganglionopathy, and pure autonomic failure.

Skin punch biopsy is a diagnostic technique that has recently become widely and commercially available to measure epidermal nerve fiber density. The 3-mm skin punch biopsy technique is a safe and minimally invasive procedure that can be performed in the office by a physician, nurse practitioner, or physician’s assistant. It causes minimal pain and discomfort and does not require sutures.  Key benefits of skin biopsy test are its effectiveness in assessing SFN when compared to other diagnostic tests. It can also be repeated multiple times to monitor disease progression