SFN Skin Punch Biopsy: Expert Small Fiber Neuropathy Diagnosis in Beverly Hills and Los Angeles.

Burning feet. Tingling hands. Stabbing pain that no one can explain. If you've been told your EMG and nerve conduction studies are "normal" but you know something is wrong, you may have small fiber neuropathy (SFN)—a condition that standard nerve tests simply cannot detect.

At Achilles Neurology Clinic in Beverly Hills, we offer small fiber skin biopsy, the gold-standard test for diagnosing SFN. This minimally invasive procedure measures the tiny nerve endings in your skin that transmit pain and temperature sensations, finally providing objective answers when other tests have failed.

Schedule your small fiber neuropathy testing with Dr. Ntranos in Beverly Hills.

Who Should Get Small Fiber Neuropathy Testing?

You may be a candidate for SFN skin biopsy if you have:

• Normal EMG results but persistent burning, tingling, or numbness in your feet or hands
• Unexplained pain described as electric-shock-like, stabbing, or "pins and needles"
• Autonomic symptoms such as abnormal sweating, heat intolerance, lightheadedness, or digestive issues
• Risk factors including diabetes, prediabetes, autoimmune conditions, or Long Covid
• Symptoms that worsen at night or follow a stocking-and-glove pattern

Small Fiber Neuropathy Testing (SFN Test) in Los Angeles

If you're searching for small fiber neuropathy testing near Los Angeles, Achilles Neurology Clinic provides expert SFN diagnosis in Beverly Hills. Our skin punch biopsy procedure:

• Directly measures epidermal nerve fiber density (ENFD) and sweat gland innervation (SGNFD) in your skin
• Detects both sensory and autonomic small fiber neuropathy
• Compares your results to age- and gender-matched normative data from Therapath laboratory
• Provides objective evidence that can guide treatment decisions

Unlike subjective symptom questionnaires, skin biopsy gives you and your doctor quantifiable data about your nerve health.

Understanding Small Fiber Neuropathy (SFN)

Small fiber neuropathy (SFN) affects the small, unmyelinated nerve fibers responsible for transmitting pain, temperature sensations, and autonomic functions throughout your body. When these delicate fibers become damaged, the resulting symptoms can be debilitating and significantly impact your quality of life.

Unlike large fiber neuropathies that affect balance and muscle strength, SFN primarily affects sensation and autonomic functions, making it challenging to diagnose with standard nerve conduction studies or EMGs. That's why specialized testing like small fiber skin biopsy is essential for an accurate diagnosis.

Common Symptoms of Small Fiber Neuropathy

Patients visiting our Los Angeles neurology clinic with small fiber neuropathy often report:

• Burning, stinging, or electrical-like pain in feet or hands
• Intense sensitivity to light touch (allodynia)
• Persistent "pins and needles" sensations
• Numbness or reduced ability to feel pain or temperature
• Autonomic symptoms like abnormal sweating, digestive issues, or blood pressure fluctuations
• Sleep disturbances due to painful symptoms
• Numbness or tingling specifically in hands

These symptoms may begin gradually and worsen over time, often starting in the feet and moving upward in a "stocking and glove" pattern. Many patients have seen multiple doctors without a clear diagnosis before finding relief through proper testing at our clinic.

What Tests Diagnose Small Fiber Neuropathy?

Several tests may be used to evaluate neuropathy, but not all can detect small fiber nerve damage:

• Small fiber skin biopsy (SFN test) – The gold-standard test for small fiber neuropathy. A 3mm skin punch biopsy measures epidermal nerve fiber density to definitively diagnose SFN.
• EMG and nerve conduction studies (NCS) – These tests evaluate large nerve fibers but typically appear normal in patients with isolated small fiber neuropathy. If your EMG was normal but you still have symptoms, a test for SFN through skin biopsy is the logical next step.
• Quantitative sensory testing (QST) – Measures your ability to detect temperature and vibration, which can support an SFN diagnosis.
• Autonomic function testing – Evaluates sweating and heart rate responses, as small fibers also control autonomic functions.

For most patients with suspected small fiber neuropathy, skin biopsy for small fiber neuropathy provides the clearest, most objective diagnosis when standard testing has been inconclusive.

Why Small Fiber Skin Biopsy Is Critical for Accurate Diagnosis

At Achilles Neurology Clinic in Los Angeles, we specialize in diagnosing complex neurological conditions that other facilities may miss. Small fiber skin biopsy is considered the gold standard for diagnosing SFN for several important reasons.

Learn more about how accurate skin biopsy is for small fiber neuropathy, including sensitivity, specificity, and what affects test reliability.

1. Definitive Diagnosis: It provides objective, quantifiable evidence of nerve fiber damage.
2. High Sensitivity: Can detect abnormalities even when other tests appear normal.
3. Minimally Invasive: Requires only tiny skin samples with minimal discomfort.
4. Measurable Results: Provides precise nerve density measurements that can be compared against normative data.
5. Progressive Monitoring: Allows us to track your condition over time and assess treatment effectiveness.
6. Comprehensive Assessment: Evaluates both sensory and autonomic nerve fibers from the same samples, detecting both types of small fiber neuropathy in one test.

The Small Fiber Skin Biopsy Procedure: What to Expect at Our Los Angeles Clinic

For a detailed walkthrough of the entire process, read our guide on what to expect before, during, and after a small fiber skin punch biopsy.

Before Your Procedure

When you schedule a small fiber skin biopsy at Achilles Neurology Clinic, our team will provide detailed instructions. Generally:

• No fasting or special diet is required
• Continue taking your regular medications (unless specifically instructed otherwise)
• Wear comfortable clothing that allows easy access to your lower leg and thigh
• Plan for a short visit – the procedure typically takes 30-45 minutes

During Your Biopsy Procedure

Dr. Ntranos and our specialized team perform small fiber skin biopsies with meticulous care:

1. Preparation and Comfort:

   • You'll be comfortably positioned for the procedure
   • The biopsy areas will be cleaned and marked
   • Local anesthetic will be applied to ensure minimal discomfort

2. The Biopsy Process:

   • Using a specialized 3mm punch biopsy tool, tiny cylindrical skin samples are removed
   • Standard locations include the ankle and thigh to compare nerve density at different heights
   • Each sample takes only seconds to collect
   • Pressure is applied to stop any minimal bleeding

3. Immediate Post-Procedure:

   • Small bandages are applied to the biopsy sites
   • No stitches are required due to the small size
   • You'll receive care instructions for the biopsy sites

After Your Procedure

• The biopsy sites typically heal completely within 7-10 days
• Most patients return to normal activities immediately
• Our team will schedule a follow-up appointment to discuss your results
• Results are typically available within 2-3 weeks

Understanding Your Results: Expert Interpretation

The skin samples collected during your biopsy are processed at Therapath, a specialized and highly reputable laboratory, where trained technicians:

1. Prepare the samples with specific immunohistochemical staining techniques
2. Calculate the epidermal nerve fiber density (ENFD) per millimeter of skin
3. Examine nerve fiber morphology for abnormalities
4. Assess sweat gland innervation for autonomic nerve fiber evaluation
5. Compare your results to age and gender-matched normative data

Dr. Ntranos personally reviews your results in the context of your symptoms and medical history to provide a comprehensive assessment. At your follow-up appointment, you'll receive:

• A detailed explanation of your results with visual aids
• Clear diagnosis based on established diagnostic criteria
• Personalized treatment recommendations
• Answers to all your questions about your condition and next steps

Autonomic Nerve Fiber Testing: Beyond Sensory Neuropathy

Small fiber skin biopsy isn't just for diagnosing sensory neuropathy—it's also a powerful tool for detecting autonomic small fiber neuropathy. The same biopsy that evaluates sensory nerve fibers can simultaneously assess the tiny nerve fibers that control your sweat glands and other autonomic functions.

What Are Autonomic Nerve Fibers?

Autonomic nerve fibers are small, unmyelinated nerves that control involuntary body functions you don't consciously think about:

• Sweating and temperature regulation
• Blood pressure control
• Heart rate variability
• Digestive function
• Bladder control

When these autonomic fibers are damaged, patients may experience symptoms of autonomic dysfunction such as postural orthostatic tachycardia syndrome (POTS), abnormal sweating, heat intolerance, lightheadedness upon standing, or digestive problems.

How Skin Biopsy Detects Autonomic Neuropathy

During laboratory analysis, technicians use the same PGP9.5 staining to visualize the nerve fibers that wrap around sweat glands in your skin. These are called sudomotor fibers, and their density can be precisely measured:

• Sweat gland nerve fiber density (SGNFD) quantifies autonomic innervation
• Results are compared to age-matched normative data
• Loss of sudomotor fibers correlates with clinical autonomic symptoms
• Research shows 80-96% sensitivity for detecting autonomic neuropathy

Who Should Consider Autonomic Fiber Testing?

Autonomic nerve fiber assessment is particularly valuable for patients experiencing:

• Abnormal sweating (too much, too little, or patchy)
• Heat intolerance or difficulty regulating body temperature
• Lightheadedness or fainting when standing (orthostatic intolerance)
• Digestive symptoms like early fullness, nausea, or constipation
• Dry eyes or dry mouth
• Heart rate fluctuations or palpitations
• Postural orthostatic tachycardia syndrome (POTS)

These symptoms often accompany the burning and tingling of sensory small fiber neuropathy, and our comprehensive biopsy analysis can determine if autonomic fibers are also affected—guiding more targeted treatment approaches.

Comprehensive Treatment Approaches for Small Fiber Neuropathy

At Achilles Neurology Clinic in Los Angeles, diagnosis is just the beginning. Once we've identified small fiber neuropathy, we develop personalized treatment plans that may include:

Medical Management

• Targeted Pain Relief: Specialized medications for neuropathic pain beyond standard analgesics
• Underlying Cause Treatment: Addressing conditions like diabetes, autoimmune disorders, or vitamin deficiencies
• Innovative Therapies: Access to advanced treatments sometimes not available at standard neurology practices

Integrative Approaches

• Nutritional Guidance: Specific dietary modifications to support nerve health
• Supplement Recommendations: Research-backed supplements that may help regenerate nerve fibers
• Physical Modalities: Specialized physical therapy and rehabilitation techniques

Lifestyle Optimization

• Activity Modification: Structured guidelines to maintain activity without exacerbating symptoms
• Sleep Improvement: Strategies to improve sleep despite neuropathic symptoms
• Stress Management: Techniques to reduce stress that can worsen neuropathic pain

Why Choose Achilles Neurology Clinic for Small Fiber Skin Biopsy in Los Angeles

As a premier concierge neurology practice in Beverly Hills, we provide exceptional care that stands apart from standard neurology practices:

Expertise and Specialization

• Specialized Knowledge: Dr. Ntranos has extensive training and experience in diagnosing and treating small fiber neuropathy
• Up-to-Date Approach: We stay current with the latest research and diagnostic techniques
• Comprehensive Assessment: We consider your entire health picture, not just isolated symptoms

Patient-Centered Experience

• Prolonged Appointments: Take the time you need to discuss all your concerns without feeling rushed
• Direct Access: Communicate directly with Dr. Ntranos throughout your care journey
• Personalized Attention: Treatment plans tailored specifically to your unique situation

Our Fee-for-Service Approach

We believe quality neurological care shouldn't be constrained by insurance limitations. As an out-of-network provider:

• We can spend more time with each patient for thorough evaluation
• We're not restricted by insurance companies in diagnostic or treatment options
• We can offer more innovative and personalized approaches

While we don't accept direct insurance payments, we provide detailed superbills for you to submit to your insurance for potential reimbursement. Many patients find that the quality of care and definitive answers they receive justify the investment in their neurological health.

Frequently Asked Questions About Small Fiber Skin Biopsy

How accurate is skin biopsy for small fiber neuropathy (SFN)?

Small fiber skin biopsy is considered the gold-standard diagnostic test for SFN, with high sensitivity and specificity. The test provides objective, quantifiable measurement of epidermal nerve fiber density (ENFD) that can be compared against established age and gender-matched normative data. When performed and interpreted by experienced specialists, skin biopsy for small fiber neuropathy is one of the most accurate and reliable tests available for confirming or ruling out SFN.

Who performs the small fiber skin biopsy procedure?

At Achilles Neurology Clinic, small fiber skin biopsies are performed by Dr. Achillefs Ntranos, a board-certified neurologist with specialized expertise in peripheral nerve disorders. Unlike some facilities where biopsies may be performed by technicians, having a neurologist perform the procedure ensures proper technique and allows for immediate clinical correlation with your symptoms and examination findings.

What is the recovery like after a small fiber skin biopsy?

Recovery after a small fiber skin biopsy is quick and straightforward. The tiny 3mm biopsy sites typically heal completely within 7-10 days. No stitches are required due to the small sample size—only small adhesive bandages are applied. Most patients return to normal activities immediately after the procedure and experience only mild soreness at the biopsy sites, similar to a minor scrape.

How does Therapath process the small fiber skin biopsy?

Therapath is a specialized, highly reputable laboratory that processes small fiber skin biopsies using advanced immunohistochemical staining techniques. Their trained technicians carefully prepare the samples, calculate the epidermal nerve fiber density (ENFD) per millimeter of skin, examine nerve fiber morphology for abnormalities, and compare your results to age and gender-matched normative data. Dr. Ntranos receives a detailed report with quantified results, which he personally reviews and explains to you at your follow-up appointment.

Is the biopsy procedure painful?

The procedure involves minimal discomfort. We use local anesthesia to numb the areas before taking the small skin samples. Most patients report feeling only slight pressure during the procedure and mild soreness afterward, similar to a small scrape.

How long does it take to get results?

Results typically take 2-3 weeks to process. We'll schedule a follow-up appointment to discuss your results in detail and develop a treatment plan if needed.

Will my insurance cover this procedure?

While Achilles Neurology Clinic operates on a fee-for-service model and is out-of-network with all insurance companies, we provide detailed superbills that you can submit to your insurance for potential reimbursement. Many insurance companies do recognize the medical necessity of small fiber skin biopsy for appropriate cases. Our staff can help guide you through this process.

What makes small fiber neuropathy different from other types of neuropathy?

Small fiber neuropathy affects the small, unmyelinated nerve fibers that transmit pain and temperature sensations, as well as autonomic functions. Unlike large fiber neuropathies that cause weakness or balance problems, SFN primarily causes sensory symptoms like burning and tingling. It also requires different diagnostic tests, as standard nerve conduction studies often miss small fiber damage.

What if my biopsy comes back normal but I still have symptoms?

A normal biopsy doesn't rule out all forms of neuropathy or other neurological conditions. If your symptoms persist despite a normal biopsy, Dr. Ntranos will work with you to explore other potential causes and treatment options. Our comprehensive approach ensures we don't stop investigating until we find answers.

How is small fiber neuropathy treated?

Treatment depends on the underlying cause and severity of symptoms. Options may include medications for neuropathic pain, treatment of underlying conditions (like diabetes or autoimmune disorders), nutritional supplements, lifestyle modifications, and physical therapy. Dr. Ntranos creates personalized treatment plans based on each patient's specific situation.

Can small fiber neuropathy be reversed?

In some cases, yes. Small fiber neuropathy caused by treatable conditions—such as vitamin deficiencies, thyroid disorders, glucose intolerance, or certain autoimmune diseases—may improve or stabilize with appropriate treatment. Research shows that small nerve fibers have the capacity to regenerate when the underlying cause is addressed. However, the potential for improvement depends heavily on early diagnosis and prompt treatment. The longer nerve damage goes untreated, the less likely it is to fully reverse. This is one reason why getting an accurate diagnosis through skin biopsy is so important. Learn more about neuropathy reversibility.

Does small fiber neuropathy get worse over time?

The progression of small fiber neuropathy varies significantly based on the underlying cause. Some patients experience stable symptoms that don't worsen, while others may see gradual progression. Key factors that influence progression include:

• The underlying cause: Neuropathy from well-controlled diabetes or treated autoimmune conditions tends to stabilize
• Treatment timing: Earlier intervention generally leads to better outcomes
• Lifestyle factors: Smoking, alcohol use, and uncontrolled blood sugar can accelerate progression

Regular monitoring through clinical evaluation and, when appropriate, repeat skin biopsy can help track whether your condition is stable, improving, or progressing—allowing for timely treatment adjustments.

Can skin biopsy detect autonomic neuropathy?

Yes. Small fiber skin biopsy can assess sweat gland innervation (sudomotor fibers) with 80-96% sensitivity for detecting autonomic small fiber neuropathy. The same biopsy samples used to evaluate sensory nerve fibers are also analyzed for autonomic nerve fiber density around sweat glands. Loss of these fibers correlates with symptoms like impaired sweating, heat intolerance, and other autonomic dysfunction. This comprehensive analysis is included in our standard skin biopsy evaluation.

What's the difference between sensory and autonomic small fiber neuropathy?

Sensory small fiber neuropathy affects the nerve fibers that transmit pain and temperature sensations, causing burning, tingling, and numbness. Autonomic small fiber neuropathy affects the nerve fibers controlling involuntary functions like sweating, blood pressure, and digestion. Many patients have both types simultaneously—a condition called mixed small fiber neuropathy. Our skin biopsy testing evaluates both sensory (epidermal) and autonomic (sudomotor) nerve fibers to provide a complete diagnosis.

Small Fiber Neuropathy Specialist in Los Angeles & Beverly Hills

If you're looking for small fiber neuropathy testing near me in the Los Angeles area, Achilles Neurology Clinic offers expert SFN diagnosis and treatment. Dr. Achillefs Ntranos is a board-certified neurologist in Los Angeles who specializes in diagnosing and treating complex neuropathies that other providers may miss.

As a dedicated biopsy doctor in Beverly Hills and Los Angeles, Dr. Ntranos performs small fiber skin biopsies in-office with the precision and expertise that comes from specialized training in peripheral nerve disorders. Whether you've been referred by another physician or are seeking answers on your own, our small fiber neuropathy specialist can provide the definitive testing and personalized care you deserve.

Schedule Your Small Fiber Skin Biopsy Consultation Today

Don't let unexplained neurological symptoms impact your quality of life any longer. If you're experiencing burning, tingling, numbness, or other concerning sensations, expert evaluation with small fiber skin biopsy may provide the answers you need.

Contact Achilles Neurology Clinic today to schedule a small fiber neuropathy evaluation in Beverly Hills with Dr. Ntranos and take the first step toward diagnosis and relief. As a neuropathy specialist in Los Angeles, Dr. Ntranos serves patients from across Southern California seeking expert SFN testing and care.

Remember, early diagnosis and treatment of small fiber neuropathy can help prevent progression and improve your quality of life. Trust Los Angeles's leading concierge neurology practice, Achilles Neurology Clinic, for exceptional care and personalized attention to your neurological health.

About the Author

Dr. Achillefs Ntranos MD

Board-Certified Neurologist
Achilles Neurology Clinic

Dr. Achillefs Ntranos MD is a board-certified neurologist and MS specialist known for his thorough evaluations and compassionate approach. Originally from Greece, he trained at Johns Hopkins University and Mount Sinai Hospital before founding Achilles Neurology Clinic in Beverly Hills to deliver comprehensive, patient-centered neurological care. He specializes in MS, autoimmune neurology, neuropathy, headaches, and other neurological disorders, blending research-driven insights with personalized treatment plans.

Learn More About Dr. Ntranos(310) 774-7025