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a Institute of Neurology,
University of Ferrara, Italy, b Department of
Neurology, c Department of Epidemiology, d Department of Neuroscience, Johns Hopkins
University, Baltimore, MD, USA
Correspondence to: Dr David R Cornblath, Pathology 627, 600 North Wolfe Street, Baltimore, MD 21287-6965, USA. Telephone 001 410 955 2229; fax 001 410 502 6737.
Received 23
February 1998 and in revised form 19 May 1998;
Accepted 1
June 1998
OBJECTIVES
To describe the neuropathological
features in skin biopsies from patients with diabetic truncal neuropathy.
METHODSThree patients with diabetic truncal
neuropathy underwent skin biopsies from both symptomatic and
asymptomatic regions of the chest and trunk. After local anaesthesia,
biopsies were performed using a 3 mm diameter punch device (Acupunch).
Intraepidermal nerve fibres (IENFs), the most distal processes of small
myelinated and unmyelinated nerve fibres, were identified after
staining with PGP 9.5 as previously described.
RESULTSDiabetes was diagnosed at the time of the
neurological presentation in two, and one was a known diabetic patient.
All three had associated sensory-motor polyneuropathy. In all, skin
biopsies showed a marked reduction of both epidermal and dermal nerve
fibres in the symptomatic dermatomes, compared with skin from
asymptomatic truncal areas. In one patient, a follow up skin biopsy
when symptoms had improved showed a return of IENFs.
CONCLUSIONSIn diabetic truncal neuropathy, skin
biopsies from symptomatic regions show a loss of IENFs. After clinical
recovery, there is a return of the IENF population, suggesting that
improvement occurs by nerve regeneration. These findings suggest that
sensory nerve fibre injury in diabetic truncal neuropathy is distal to or within the sensory ganglia. Skin biopsy provides a possible tool for
understanding the pathophysiology of the disease.
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