Skin Biopsy to Diagnose Small Fiber Neuropathy (ENFD)
Performing a skin biopsy to analyze and quantify nerve fibers in the epidermis is a relatively simple and convenient way to identify and monitor small fiber neuropathies. Studies support the high sensitivity and the specificity of skin biopsy in detecting small nerve fiber loss and it has been used not only in diagnosis, but also to evaluate disease progression and treatment success. ENFD studies have been found to have 88.4% sensitivity in detection, compared with 54.6% for clinical exams alone. Moreover, the test can detect early nerve fiber damage even in asymptomatic patients.
Toenail Fungus Pathology
There are multiple types of fungus that may cause an infection of the toenails. Toenail fungus is most commonly caused by a type of mold known as dermatophytes. Often, toenail fungus begins with an infection of the foot (athlete’s foot) which then spreads to the toenails. Fungi tend to proliferate in warm, moist, dark areas, and infections can be incurred by walking barefoot in a public space such as a shower, locker room, or swimming pool area. While toenail fungus can affect people at any age, it is most likely in older adults. You are more likely to get a fungal infection if you have reduced circulation due to diabetes or an autoimmune condition. Your risk is also heightened if your feet sweat a lot, or if you often get athlete’s foot. Sores or wounds on the feet may make you more prone to developing a severe fungal infection.