Small fiber neuropathies

Eduardo Adonias De Sousa MD (Dr. De Sousa of The University of Oklahoma Health Sciences Center has no relevant financial relationships to disclose.)
Louis H Weimer MD, editor. (

Dr. Weimer of Columbia University has received consulting fees from Roche.

Originally released June 7, 2010; last updated January 24, 2017; expires January 24, 2020


The task of confirming a diagnosis of suspected small fiber sensory neuropathy can be difficult. The author presents a basic overview of the subject. Key diagnostic elements are history and physical examination in combination with normal electrodiagnostic tests. Laboratory tests may reveal associated disorders, although some cases are idiopathic. Punch skin biopsies may show reduced intraepidermal nerve fiber density. Subclinical autonomic involvement may be detected with additional tests. There is no treatment for numbness. Neuropathic pain and dysesthesias may be treated with medications and nonpharmacological therapies.

Key points


• Small fiber sensory neuropathy often presents with length-dependent numbness or pain due to abnormal somatic unmyelinated or small myelinated nerve function.


• Important associated conditions include diabetes, toxic agents, Sjogren syndrome, and amyloidosis.


• There is no consensus on a gold standard diagnostic test, so the diagnosis is based on history, clinical examination, normal nerve conduction studies, and supportive laboratory evidence, including intraepidermal nerve fiber density analysis on skin biopsy.


• Autonomic tests may be abnormal, even in the absence of overt autonomic symptoms.


• There is no treatment for numbness, but there are pharmacologic and nonpharmacologic treatments for neuropathic pain.

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