Skin biopsy question
 

Hi..my skin biopsy results show a loss of blood vessels, follicles and glands along with reduced nerve fibers <1st percentile. I was told I have a ganglionopathy but I don't know what the complications from the loss of blood vessels, glands and follicles will be. This biopsy was at the ankle (thigh was "better preserved"). Does anyone have knowledge of this? Thank you! :confused:

I'll have to defer to Glenn, for this question. I can only speculate, as I haven't come across this before with loss of blood vessels, glands, follicles. I do know that hair stops growing on the legs for some with SFN, which I would guess is from reduced follicles. But this doesn't explain the blood vessels.

Let's see what Glenn has to say.

Hi, Does your results shows reduced blood vessels, follicles and sweat glands, or a reduction of the nerve fibers that innervates them ?
The small fibers are sensory and autonomic fibers, the autonomic nerves innervates these organs and they might be affected by SFN.
So the biopsy usually tests for these innervations as an indication for the condition of the autonomic nerve fibers.
The sympathetic branch of the autonomic system innervates the blood vessels and it controls their constriction/dilation (For example increasing the blood flow to an active area that needs more blood, or to an injured area to improve it's healing). When it is affected the blood vessels still exists and the blood reach the feet, but their regulation is damaged. For example I had felt that my feet are freezing. After getting Rituximab (my SFN is likely autoimmune) the first sign of improvement was that my feet defrosted:)
I hardly have any hair left on my legs, and I stopped sweating in my legs and arms, I don’t know whether the glands and follicles dies when they aren’t activated by the autonomic system and whether this is reversible.

Was the ganglionopathy diagnosed based only on this biopsy or did you have other tests ?

is it only with SFN that hair stops growing on the affected areas such as legs and arms? i have long fiber sensory motor PN confirmed by emg/ncs since 2001. i have never looked into subsequent small fiber involvement though i have suspected it. I didnt see the point since i had a cause and it changed nothing treatment wise. i have no hair on my legs below the knee and little from the knee up. i have less hair on the back of my hands than i used to also.

As far as I know the hair follicles are innervated only by autonomic small fibers and not by large fibers.

Thank you so much for your reply. It makes sense to me although the doctor never talked about the autonomic system. The ganglionopathy was diagnosed based on my symptoms (clinically I guess you would say) because I have tingling and burning sensations everywhere, for 2 1/2 years now. Not all at once but it moves around. My lower legs feel like they have tight bands around them. My feet are always cold and I think my big toes are getting numb. I did have all the tests (EMG/NCS, MRI, B12, VitD, IgG, IgM, IgA, etc.) and the only one positive was ANA. It was 1:160 Homogenous. All the tests for Lupus were negative though. I do have Raynaud's and have had it since I was very young. My doctor suspects autoimmune as well ( Sjogrens ) but no symptoms or tests to support it yet (Ro and La negative). I will ask my doctor about the autonomic system. Thanks again. So scary not knowing what to expect. My doctor told me to think of this as an "annoyance" and forget about it and just live my life. How do I do that when I am in pain and so worried? Geez. :(:

I forgot to answer your first question.....yes, there is also a significant reduction in nerve fibers. It states it is diagnostic of axonopathy and small fiber polyneuropathy. Thanks!

I personally have not ever seen--
 

--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 :thud::thud:

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! :confused:

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. :hug: 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.