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Skin punch biopsy
The skin punch biopsy is a form of skin biopsy typically used to diagnose small peripheral fiber neuropathy. This procedure allows a lab to analyze the density of nerve endings in the sample, which can help verify and diagnose post herpetic neuralgia, restless leg syndrome (RLS), toxic and idiopathic neuropathies, HIV-associated and diabetic neuropathy, scleroderma, and various forms of autonomic dysfunction. This test is generally used at sites that are not easily tested through electrophysiology. More recently, this test has been used to also evaluate sweat gland density, a factor useful in helping to diagnose XXX.

History
The presence of nerve fibers within skin was first documented in 1968 by Paul Langerhans, while he was still a medical student. It wasn’t until 1990 in Stockholm that Lan Wang, Marita Hilliges, Tomas Jernberg, Desiree Wiegleb-Edstrom and Olle Johansson were about to some the human epidermis in better detail using more sensitive staining methods.

William Kennedy of the University of Minnesota was one of the first people to observe that diabetic neuropathy is visible in the different types of nerve fibers. In 1993,he published results of a study that conclusively established the existence of epidermal nerve fibers (ENFs) by confocal microscope. He was able to establish the link to diabetic neuropathy in 1996.

The Johns Hopkins Cutaneous Nerve Laboratory, established in 1993, was the first CLIA-certified laboratory to use epidermal nerve fiber analysis, as obtained by a skin punch biopsy, as a diagnostic tool. Guiseppe Lauria of the Instituto Nazionale Neurologico ‘C. Besta’ in Milan, along with Justin McArthur and other researchers at Johns Hopkins, demonstrated in 1998 that the skin punch biopsy could be used to assess the extent and degree of nerve fiber damage in sensory neuropathies and that age is not a factor in the interpretation.

Skin Punch Biopsy Procedure
A cutaneous nerve/skin biopsy is a minimally-invasive procedure performed in the outpatient setting. The procedure generally takes 10 to 15 minutes.

The skin is thoroughly cleaned and a small injection of a local anesthetic is applied to numb the skin. A sample of skin is taken by a biopsy from the numb area of the skin. A band-aid dressing is used to cover the biopsy site. Generally, the skin heals easily within one to two weeks.

Skin Punch Biopsy in Research
The skin biopsy is used by researchers to evaluate