--a Skin biopsy report that goes into detail about blood vessels and glands along with the information about density and condition of nerve fibers.

It might make sense, though, for a small fiber neuropathy of long standing to result in the "withering" of other structures that the small nerves ennervate, since if they are not functioning signals cannot adequately get back and forth to them.

However, that report does sound as if there is some vasculitic autoimmune process involved. The ANA related autoimmunities, which do include lupus, Sjogren's, Bechet's, Churg-Strauss, and a host of other syndromes do often involve an attack on the components of blood vessels and glandular structures such as sweat glands, as well as neuropathies.

I'll have to research this further--can you tell us where the results were interpreted (which hospital/research facility)?

Sure....the skin biopsy was interpreted by Dr. Anne Louise Oaklander at Mass General Hospital in Boston. My neurologist conveyed the results. He only asked about "feeling full quickly" and "bloating" which I don't have. My dermatologist tested me for ANTI PR3 and ANTI AMO ANCA which showed a nuclear pattern which is "not characteristic of an ANCA associated vasculitis". I did not even know she was testing me. I had a rash on my lower leg. I only see the results in my electronic medical chart. Nothing ever became of that test. Thanks so much for your help. I am just a mess

I just reread my skin biopsy and I think stillHoping is right. It states "thick sections revealed marked reduction of innervation of epidermis and of dermal structures such as glands, hair follicles, and blood vessels consistent with axonopathy of small cutaneous sensory axons". So does this mean that the glands, follicles and blood vessels are still there just not getting the blood (circulation) they need to function properly vs "being destroyed?" I wish the doctors could show me a picture of what is actually happening!

Yes, if there weren't any sweat glands and hair follicles in the sample they probably couldn’t check their innervations.
When the small fibers that innervates these structures are affected there is a reduction in the regulation of these structures (by neurotransmitters such as Acetylcholine, Norepinephrine) they don’t get the commands to sweat, dilate and constrict the blood vessels etc., so the damage isn’t caused by reduced blood flow .
Although I guess it might happen indirectly, since the small fibers innervates the blood vessels then there might be also a problem with blood supply to the area.

This all makes sense, thank you. I guess I have to pay attention to other possible signs of autonomic issues. That was my concern along with circulation. My late husband had type 1 diabetes since age 7 and had diabetic neuropathy as well as CICP so seeing all that isn't helping me right now. I appreciate your help though...it means a lot. I am still curious about what triggered all this as I am sure many of us are.

summerfun - just wanted to pipe in and say that when I had my skin biopsy they did an epidermal nerve fiber density (ENFD) and sweat gland nerve fiber density (SGNFD) count. Sounds like they may have done something similar for you - mine also showed significant reduction of nerve fibers in the sweat glands which would suggest autonomic and/or SFN.

Thanks for letting me know. I have left a message for my doctor so when he gets back to me I will let everyone know.