--that yes, a skin biopsy is the current "gold standard" for for determining if there is a small fiber neuropathy.

It's much easier to tolerate than a nerve biopsy, as well--a few shots of local anesthetic, a few 3mm wide by 1mm deep skin samples taken, a few band aids, and it's done--the samples are sent off for electron microscopy to determine the intraepidermal nerve fiber density and condition.

In my case, for example, the biopsy revealed a non-length dependent small fiber neuropathy. Nerve fiber density was significantly reduced as both ankle and thigh sites (many will also take a back-of-arm by the elbow sample), and the nerve fibers that were in evidence there were swollen and inflamed.

Unfortunately, skin biopsies aren't very good at determining the CAUSE of such a situation. Once in a while, more specialized testing of the samples might reveal something. (I had mine tested for amyloid--fortunately negative.)

There are a lot of people out there with skin-biopsy documented small-fiber neuropathy with severe symptoms still looking to determine a cause. Many have had a lot of the tests listed in the Liza Jane spreadsheets for neurologic symptoms (see: www.LizaJane.org--you can see what you've had to date in comparison) and they've all come back negative/normal. It's estimated that a good third or more of all small fiber syndromes are idiopathic.