What podiatrists need to know about dermatopathologists


Q&A with two Bako Diagnostics dermatopathologists: Kim Whisenant, M.D., and Carolina Montes, M.D. on partnering with podiatrists Q. What is the importance of podiatrists being familiar with pathology, specifically dermatopathology? A. Dr. Montes: The skin is the largest organ of the body, and many medical specialties, including podiatry, come in contact with disorders of the skin. Lesions that appear on the skin, including the foot, can also be a manifestation of internal systemic disease. Consequently, it’s important for clinicians to be familiar with both inflammatory and neoplastic processes of [...]

What podiatrists need to know about dermatopathologists2021-03-09T14:30:28-05:00

How Epidermal Nerve Fiber Density is used to diagnose and treat patients with small fiber peripheral neuropathy


Diagnostic confirmation allows for the most effective treatment  BakoDx’s epidermal nerve fiber density (ENFD) analysis is an objective diagnostic tool used to monitor and manage patients with small fiber peripheral neuropathy (SFPN). The analysis not only provides definitive confirmation of SFPN, but also enables better assessment of the severity of the neuropathic process, which may have treatment implications. ENFD analysis may also reveal degenerative changes in those patients with normal densities, which may predict the future onset of SFPN. SFPN may present with varying symptoms, however, most commonly presents with burning/shooting pains, pins and needle sensation or numbness and [...]

How Epidermal Nerve Fiber Density is used to diagnose and treat patients with small fiber peripheral neuropathy2020-11-30T09:54:17-05:00

Why ENFD Analysis Provides the Best Tool to Confirm Small Fiber Peripheral Neuropathy


One quick in-offi­ce procedure can provide a definitive diagnosis, allowing for effective treatment and symptom relief Have patients complained of burning pain, tingling, numbness, or a pins and needles feeling of the lower extremity? This could be an indication of small fiber peripheral neuropathy[1] (SFPN), a condition that can be definitively confirmed with a quick, in-office punch biopsy procedure and epidermal nerve fiber density (ENFD) analysis. “For the early detection of small fiber peripheral neuropathy, ENFD analysis is the best objective tool,” says Dr. Wayne L. Bakotic, Medical Director at BakoDx. “The ENFD diagnostic test allows for the confirmation [...]

Why ENFD Analysis Provides the Best Tool to Confirm Small Fiber Peripheral Neuropathy2023-01-04T15:07:24-05:00

Epidermal Nerve Fiber Density Testing : An Overview


Here’s a technique for the evaluation of small fiber peripheral neuropathy. Introduction Epidermal nerve fiber density (ENFD) testing is not a new technique; however, it is new to the diagnostic armamentarium of many in the podiatric community. This analysis is quickly becoming recognized as the gold standard among clinicians when assessing for the presence, and the degree, of small fiber peripheral neuropathy. Though podiatric clinicians have only recently discovered this test, it has been an important diagnostic procedure for neurologists for many years. In fact, ENFD analysis has been widely used by neurologists in the United States and in Europe, to [...]

Epidermal Nerve Fiber Density Testing : An Overview2017-10-06T15:49:14-04:00

Current Concepts in Psoriasis Therapy


Largely unchanged for decades, treatment methods for this potentially disabling condition are finally evolving. Introduction Our ability to treat adverse medical conditions has long been an admixture of miraculous accomplishment and frustrating stagnation. For every disease such as osteogenic sarcoma, where recent therapeutic breakthroughs have lifted cure rates from 10-20% to over 90%, there is a condition like pulmonary adenocarcinoma, where cure rates approach their historic controls. The management of dermatologic disorders has not offered any particular exception to this rule. There recently have been profound advances in the medical management of inflammatory conditions of the skin; however, many of those [...]

Current Concepts in Psoriasis Therapy2017-10-10T11:44:04-04:00

Needle Aspiration Biopsy


Needle aspiration biopsy is amongst the most underutilized diagnostic procedures of those available. This technique may be effectively used to rule out high‐grade malignancies when faced with nonspecific subcutaneous masses, in particular, those masses that resemble ganglion cysts. I once had three different medico‐legal cases under consultative review at one time, all of which were centered on patients who had non‐specific ganglion‐like masses. In each instance, the patient actually harbored a high‐grade sarcoma, and in each case, they were followed into their grave by their clinician with the errant diagnosis of “ganglion”. It is not overtly surprising that neoplasms masquerading as [...]

Needle Aspiration Biopsy2017-10-10T11:44:36-04:00

Cutaneous Biopsy Techniques in the Management of Chronic Wounds


Many clinicians rely exclusively on clinical acumen when determining how to manage chronic wounds. Though an ulcer’s clinical features may be fairly indicative of its etiology, in some instances, such is not the case. Even among the most characteristic‐appearing ulcerations, masqueraders do exist. Ruling out the possibility of an unsuspected neoplastic or inflammatory condition could be necessary for the successful management of chronic wounds. In this context, cutaneous biopsy techniques may be invaluable; however, their utility does not necessarily end here. There are three common clinical settings in which a biopsy may be used in the management of a chronic wound. [...]

Cutaneous Biopsy Techniques in the Management of Chronic Wounds2017-10-10T11:45:02-04:00

Biopsy Planning and Post-Biopsy Tissue Handling : A Synopsis


Introduction As a general rule, the podiatic profession is notorious for its underutilization of cutaneous and soft tissue biopsy techniques. In some instances, such under-use may be attributed to trepidation stemming from a lack of familiarity with the biopsy techniques themselves; however, I believe this is not the preeminent cause. In my experience, the most common reason that many podiatric clinicians don’t use biopsy techniques to their fullest is a degree of insecurity regarding when to use witch biopsy and what to do with them once the biopsy has been performed. In most offices, the support staff is ill prepared to [...]

Biopsy Planning and Post-Biopsy Tissue Handling : A Synopsis2017-10-10T11:45:19-04:00

Epidermal Nerve Fiber Density Testing


A New Gold Standard for the Diagnosis of Small Fiber Neuropathy What is small fiber peripheral neuropathy and when might I be expected to see it amongst my patients? Small fiber peripheral neuropathy is a form of neuropathy that is limited to the terminal, intra-epidermal ends of sensory nerves. This expression of peripheral neuropathy commonly presents in a stocking or glove-like distribution. Those that exhibit neuropathy in this pattern, without involvement of large nerve fibers are said to have pure small fiber peripheral neuropathy. If the nerve pathology progresses proximally to involve larger nerves, the neuropathy becomes mixed. Of course diabetics [...]

Epidermal Nerve Fiber Density Testing2017-10-10T11:45:51-04:00
Go to Top