The Epidermal Nerve Fiber Density (ENFD) test is an objective method of documenting small fiber peripheral neuropathy by quantifying the terminal branches of peripheral nerves within the epidermis. The test is highly specific and sufficiently sensitive with 97% of accuracy rate. The test is recommended to perform when patients experience the following symptoms: pain and abnormal sensation (burning, prickling, shooting), as well as numbness, tightness, coldness in foot/ankle areas.
The common causes of small fiber peripheral neuropathy are: diabetes, types I & II; HIV; vibratory trauma; amyloidosis / monoclonal gammopathy; alcohol abuse; pharmacologic toxins (metronidazole); solvent exposure, and idiopathic neuropathy, when the cause can’t be determined, once thought to represent as much as half of all cases.
The ENFD test can also be used to predict the small nerve fiber peripheral neuropathy.
A small 3×3 mm skin biopsy is used for providing diagnostic information on small nerve fibers. The ENFD biopsy is superficial with a very low risk for infection. We provide doctors with the ENFD kit that contains everything necessary for performing the small surgery/skin biopsy, including Zamboni’s fixative, phosphate buffer and cryoprotectant.