--that increased intraepidermal nerve fiber density as measured through staining may represent an early phase of small-fiber damage, as the body attempts to fight the process through increased branchings. Of course, it may be hard to distinguish this in a skin-biopsy "snapshot" from nerve regeneration.

A good electron microscope analysis can often distinguish these increased branchings from regeneration by looking for evidence of fiber deterioration, notably in the form of fiber swellings. But one needs to have such things looked for, and by an experienced micro-pathologist.

Take a look at this, which sort of summarizes this obervational difficulty:


http://www.medscape.org/viewarticle/563262_5



Fortunately, skin biopsy, while it generally cannot reveal a cause for neuropathy, is reproducable over time, so density and condition of nerve fibers in the same body areas can be repeatedly sampled and often that is a better indicator if neuropathy is progressing, healing, or merely stable.

Thank you Glenn for that clarification, i couldn't click on the link though. Do you think it could be possible that the Metronidazole caused this? I took two lots just before onset of symptoms?

Metronidazole and its newer cousin have been shown to cause neuropathy:

from http://www.ncbi.nlm.nih.gov/pubmed/16901452

While it is considered by some to be reversible, it also causes lesions in the brain, and we have had some posters here where the peripheral neuropathy did not reverse. So it may be a trigger for those who are CMT candidates.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2963744/

Metronidazole shares some metabolic pathways with alcohol...so that it suggests use of Thiamine or benfotiamine may help with repair from it use.
The build up of aldehydes in the body may be causing the burning pain for some people.

Hi Lou Lou, I believe that we saw the same Professor for our skin biopsy. He said in advance of my test that there is the possibility that the nerves will be inflamed or affected by inflammation and will therefore show signs of 'splitting', he also used the words regeneration. I think he meant that if they are splitting they will appear to be regenerating as there will be more fibres due to the splitting of the original ones. So you aren't mad, this is exactly what he explained to me. It seems really feasible that there would be splitting and therfore more fibres as a result of that. Just hope that helps you with any treatment for the underlying cause.

Thank you Mrs D and Joanna, when I have looked up metronidazole it seems to be a length dependent thing for sfn,i haven't read anything about it being non-length dependent. also I only used it twice before symptom onset.

Thanks again Mrs D
Although I had some symptoms of PN prior to an emergency appendectomy in Oct 2014, I was wondering why it had suddenly increased and spread over my entire body since. Have just checked the medical notes from the surgery and found I was given Metronidazole while in hospital, (first time taking it). Yet another possible cause to mention to the neuro when I finally get an appt. With the amount of info I've learned from this site I'll need to be careful not to annoy the doctor - especially if he gives a diagnosis of idiopathic PN - which from what I've read here seems to be the answer they give when they either don't know or can't be bothered looking further.