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Skin wrinkling for diagnosing small neuropathy: Comparison with epidermal nerve density and SSR
  1. Hock Luen Teoh
  1. National University Hospital, Singapore
    1. Adeline Chow
    1. Yong Loo Lin School of Medicine, National University Singapore, Singapore
      1. Einar P Wilder-Smith (mdcwse{at}
      1. National University Singapore, Singapore


        Objective: To compare simple tests of small nerve fibre function, with intraepidermal nerve fibre density (IENFD) in the evaluation of small fibre neuropathy (SFN).

        Methods: Patients with idiopathic SFN of the hands were prospectively studied. Evaluation involved clinical examination, nerve conduction studies, SSR, water and EMLA (eutectic mixture of local anesthetics) skin wrinkling.

        Results: Of 21 patients, 16 (76.2%) had low IENFD, 15 (71.4%) impaired water-induced wrinkling, 14 (66.7%) impaired EMLA-induced wrinkling and 9 (42.9%) abnormal SSR.

        Conclusions: Stimulated skin wrinkling was nearly as sensitive as IENFD in the diagnosis of SFN, SSR were of less use. Stimulated skin wrinkling is a useful supportive test where IENFD or other tests of small nerve fibre function are not available.

        • EMLA
        • Nerve Fibers, Unmyelinated
        • Sensory and Autonomic neuropathies
        • Skin Wrinkling
        • Sympathetic Fibers, Postganglionic

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