Diagnostic utility of small fiber analysis in skin biopsies from children with chronic pain

Introduction Small fiber neuropathies (SFN) are associated with a reduction in quality of life. In adults, epidermal nerve fiber density (END) analysis is recommended for the diagnosis of SFN. In children, END assessment is not often performed. We analyzed small nerve fiber innervation to elucidate...

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Bibliographic Details
Published in:Muscle & nerve 2020-02, Vol.61 (2), p.173-181
Main Authors: Görlach, Jonas, Amsel, Daniel, Kölbel, Heike, Grzybowsky, Michelle, Rutsch, Frank, Schlierbach, Hannah, Vanlander, Arnaud, Pogatzki‐Zahn, Esther, Habig, Kathrin, Garkisch, Stefanie, Müller, Verena, Fritz, Thorsten, Ziegler, Andreas, Hahn, Andreas, Krämer, Heidrun H., Van Coster, Rudy, Schänzer, Anne
Format: Article
Language:English
Subjects:
Adolescent
Biopsy
Child
Children
Chronic pain
Chronic Pain - diagnosis
Chronic Pain - pathology
Density
Diagnostic systems
epidermal nerve fiber density
Epidermis - innervation
Epidermis - pathology
Exocrine glands
Female
Fibers
Genetic disorders
Humans
Innervation
Male
Medical diagnosis
Nerve Fibers - pathology
Neuralgia - diagnosis
Neurites - pathology
neuropathic pain
Neuropathy
Pain
Pain Measurement
Patients
Quality of life
Reduction
Skin
Skin - pathology
skin biopsy
small fiber
small fiber neuropathy
Small Fiber Neuropathy - pathology
sudomotor neurite density
sweat gland innervation
Sweat Glands - innervation
Sweat Glands - pathology
Therapeutic applications
Young Adult
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Summary:Introduction Small fiber neuropathies (SFN) are associated with a reduction in quality of life. In adults, epidermal nerve fiber density (END) analysis is recommended for the diagnosis of SFN. In children, END assessment is not often performed. We analyzed small nerve fiber innervation to elucidate the potential diagnostic role of skin biopsies in young patients with pain. Methods Epidermal nerve fiber density and sudomotor neurite density (SND) were assessed in skin biopsies from 26 patients aged 7 to 20 years (15 female patients) with unexplained chronic pain. The results were compared with clinical data. Results Epidermal nerve fiber density was abnormal in 50% and borderline in 35% of patients. An underlying medical condition was found in 42% of patients, including metabolic, autoimmune, and genetic disorders. Discussion Reduction of epidermal nerve fibers can be associated with treatable conditions. Therefore, the analysis of END in children with pain may help to uncover a possible cause and guide potential treatment options.
ISSN:0148-639X
1097-4598
DOI:10.1002/mus.26766