--there are some problems with interpretation of skin biopsy results (I've written extensively about these here before), in that unless the intraepidermal fiber density is below the fifth percentile or above the 95th most clinicians will say it is normal (according to the McArthur protocols--the original norming studies at Johns Hopkins).

But, that doesn't mean one can't have a neuropathic process going on. I used the example of someone who shows up at the 17th percentile. That would be considered normal, but suppose before their syndrome began they would have shown up at the 40th percentile, or something like that. There would be no way to know, as people, except those involved in research studies, don't get skin biopsies when they are feeling WELL.

On the other hand, those "axonal swellings" may need to be investigated further; some normals can have occasional swellings in a sample but if they are widespread it increases the likelihood that there is something going on. And, the good thing about skin biopsies is that they are repeatable--samples can be taken down the road from the same areas and compared to see if there are increases/decreases in nerve fiber density and if the condition of the fibers changes/gets worse/gets better.