Skin Biopsy: What's It Like
 

So I might be getting a skin biopsy. What's the procedure like? Are there any risks? Is it an accurate test?

It is the most accurate test available for small fiber neuropathy.

It is a punch biopsy, which means it is about 3 millimeters in width, and it is a perfect round circle, that gets punched out of your skin-pretty far down, so it gets the whole thickness.

They numb the area, but it is a deep cut, do I still felt it a bit-but nothing crazy.

I kept it bandaged for a little over a week because it is deep. I still have a bit of a scar from my two biopsies, but the fade as time goes-the one on my ankle slower than the one on my thigh-but everything heals slower at the ankle due to its distance from the heart.

I had two locations done-upper thigh and ankle-both outer (distal). Not sure if it is common or not to have two biopsies taken at once. For me, I'm glad, as it showed my neuropathy was not length dependent, as I had damage in both the ankle and the thigh.

Dang!!

I was planning on entering a beauty contest...guess I might need to reconsider :eek::D

My neuro just said they will discuss with my insurance company to see if it's covered.

Ellsac's descriptions is pretty accurate. The worst of the procedure is the numbing shot, so it's not bad at all. You leave with a band-aid and instructions to keep dry for a few days.

I had 3 sites done on each leg. Mine were the typical locations...ankle, just above knee and thigh. Some doctors only do two sites. You need at least two site in order to determine length/non-length dependent neuropathy.

It's really no big deal...you'll do fine. It's very accurate as they get to look directly at the small fibers, so they can determine density % as well as condition of the fibers.

Skin biopsy & steroids?
 

Hi - I read somewhere that if you're taking steroid medication it will affect the results of a skin biopsy. Does anyone know if this is true? and to what degree - ie: does it mean that a skin biopsy isn't feasible for those on steroids?
Thanks for any info.

UTGrad - all the best for the 'punches' - hope you get some answers.

Interesting. I'm taking a nasal steroid

OK UtGrad
So I did a quick search to see if I could find out more about skin biopsy and steroids - only thing I found so far to confirm it was on a Veterinarian site (ie for animals - apparently they get skin biopsies as well!)
But I also came across this neurology journal site article with detailed info on skin biopsies and PN:
http://www.nature.com/nrneurol/journ...neuro0630.html
I'll post it in the PN tips thread as well.

Thank you...that was an excellent link

I have autoimmune Addison's disease, and take steroids everyday. It is a very small physiological dose that only replaces what my body doesn't make on its own, but none of the neurologists I have seen mentioned it affecting the skin biopsy at all.

The most steroids could do is lessen inflammation in the body, but if your nerves are damaged and dying off, it'll show up regardless I would think, as mine did.

same description as ellsac. I had mine in the end of November and they are healed but dark purple color.
It is very important that they take a spot from the upper leg as well. Mine indicated much more significant damage there.

That is a really good link. Thank you so much for finding and posting it here.

Hi Ellsac
Thanks for this - I too have primary Addison's, which is why I was asking. I had nerve conduction & EMG tests for PN in Aug 2014 - both negative. But since an emergency appendectomy in Oct 2014 (with large doses of IV hydrocortisone), my neuro symptoms have increased. Waiting to see a neurologist and from reading the PN forum was guessing that skin biopsy might be next step.

However from my own research I'm suspecting my PN might be due to B12 deficiency, (which could mean incomplete APS 4). Neuro wait is about 3 mths but seeing my Endo on Monday so will hopefully take another step forward.

My story is at: http://neurotalk.psychcentral.com/thread218283.html

My B12 numbers were ok, but I started methyl b12 and methylfolate any way along with a couple of other supplements.

I have heard of larger doses of steroids causing a decrease in neuropathy symptoms-but not the other way around. I would think that is too much cortisol caused neuropathy-it would be a major symptom of Cushings Disease, and it doesn't seem to be (unless of course the excess cortisol is so prolonged in ones system that it causes diabetes or the like-although this would be reversible if the cortisol levels were brought back down).

That being said, blood sugar regulation and thyroid problems have been shown to lead to neuropathy, and there are many stories about women hitting menopause and getting neuropathy, so certainly hormones play a part, and us Addisonians have a harder time keeping our hormones balanced in general.

I hope your endo takes regular bloods? I get blood drawn every 4-6 months to check my ACTH level (to make sure I'm not over-replaced on cortisol), blood pressure, thyroid, liver, kidneys, blood sugar, electrolytes-whole shebang! haha.

When the small fiber neuropathy kicked in, I first thought maybe overrplacement causing high blood sugar, but not the case for me. If anything I run under replaced.

Sorry you have Addison's-but nice to meet another one :)

[QUOTE=ellsac;1135623]
I have heard of larger doses of steroids causing a decrease in neuropathy symptoms-but not the other way around. I would think that is too much cortisol caused neuropathy-it would be a major symptom of Cushings Disease, and it doesn't seem to be (unless of course the excess cortisol is so prolonged in ones system that it causes diabetes or the like-although this would be reversible if the cortisol levels were brought back down).

Sorry ellsac - I didn't word that very well - I don't think the extra steroid increased the PN - more I was concerned that it may have an effect on a skin biopsy result - although given the time lag now it should be okay. What I think may have contributed to the PN is a drop in B12 due to Nitrous Oxide during the op, (plus other factors). Also I was given Metrodiazanole (antibiotic) which PN is a known side effect of.

Yes my bloods are monitored every three months - glucose has always been good and thyroid has been stable since I added iodine to my diet. I normally see the Endo once a year but they scheduled a six monthly follow up due to the apx - but I've asked for it to be brought forward.

I'm fortunate in that although the Addison's numbers in NZ are small, and there is no official support group, we have a loose network in which we share information - the co-ordinator is a retired pharmacist who's had AD for 50 years - very helpful. It's a roller-coaster ride though and 5 years in I'm still learning.

[QUOTE=bluesfan;1135642]
You live in New Zealand? That's AWESOME!!

NZ is in my opinion one of the most magnificent countries in the world. Low crime, beautiful scenery, great standard of living and really good deer hunting in the mountains!

[QUOTE=UTGrad;1135647]Thanks UTGrad
I know I'm fortunate in a lot of respects to live here but the wait times to get specialist healthcare sometimes make me wish I was back in the US and the standard of living for those who are unable to work is no better than the US. I spent many years when I was younger traveling/working overseas but NZ has always been home.

Just got a message from my neuro office. They are still waiting to hear back from my insurance about coverage for a skin biopsy. Dang it's a long wait lol

Mine is scheduled for next week. It really will just tell you whether or not you have nerve damage. Still doesn't address the cause. It might not show any damage if you have early SFN.

Anyone know if its possible to have parasthesia, buzzing, etc without doing any actual nerve damage?

I'll let the experts chime in but I think you can.

Yes it is. I'm one of those people who had a normal skin biopsy, but significant symptoms. There are others likes this on this message board and also a facebook group that I'm in.

What's the medical explanation for SFN symptoms with a normal skin biopsy? I could see myself getting the test and it come back normal.

I think this is once of my biggest fears: Having x, y, z symptoms, several tests ran, and all normal results. I guess the wait on the FIRST neuro appt will at least buy me some time for possible damage to show!! I have been scheduled for an appt now for over a month. I can't complain, for I have seen many on this forum having to wait ages. I'm just ready to get my life back.

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Well I have body wide symptoms, but the symptoms in my upper body are the worst. I have damage in my arms - can't feel temperature change and it hurts to have clothing touching my arms some days. My neuro took skin punch samples from one of my legs and told me that they don't take arm samples. So it really depends on your situation.

It was my total fear - I have all normal results. My old primary didn't even think that the temperature loss in my arms was of significance. He just kept saying that it didn't make sense; he didn't seem to understand much, frankly. So I dropped him and my HMO like a hot potato. It made total sense to the Neurology dept, thankfully I live in a city with a big teaching hospital that sees everything. So I do feel vindicated. Unfortunately, neurology recommended the pain clinic as I figured they would.

I use to be fearful of never finding the answers to what was causing this terrible pain. I was lucky that my SFN was diagnosed by a biopsy within 6 months. Then all the testing started to find the reason for the neuropathy. So many test with no answers. I believe it was fluoroquinolone toxicity. It took me six years to go bak in my records and find out I was on the antibiotic when I first developed the pain.

Unfortunately, knowing the answer doesn't change the treatment for me. I'm told from now on it is just a matter of pain management. I'm trying as hard as I can to accept it. Little by little I'm getting there.

Thanks...will see if it gets approved through United Healthcare.

I'm at the two month mark of the onset of symptoms and nothing really has changed except maybe a slight improvement from the initial onset.

Just got an email from my neurologist that my insurance does not need prior authorization to conduct the skin biopsy. My neuro said he has ordered the kit and will work me in when it arrives.

Quick question:

How long does it take for the results once the test is completed? I'm assuming it has to be sent to a lab.

For my biopsy, they told me 6-8 weeks, but had some results completed after 2 weeks. The rest of the results were done by week 6. Mine was an in-house situation...which is not common. Many hospitals send their skin punches to Therapath.

The should be able to examine the sample to rule out vasculitus and amyloidosis; they will also examine the quality and quantity of nerve fibers. I think I also had to avoid any type of anti-inflammatory before the test. And make sure you think about the spots that hurt the most and have them take the sample from that leg. Good luck!

Thank you very much. Good to know the test can rule out vascular issues as well.