Together with our physicians and patients, we are driven to help diagnose and better treat
small-fiber neuropathy!
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Key Points

  • Skin biopsy for Epidermal Nerve Fiber Density (ENFD) testing is a reliable tool for diagnosing small-fiber neuropathy (SFN).
  • The sensitivity of skin biopsy in diagnosing small fiber neuropathy has been reported to be 88%.
  • This is in comparison to 54% for the clinical examination, and 49% for quantitative sensory testing (1).
  • The specificity of the test is 98% (1).
  • Many diseases are associated with SFN such as diabetic neuropathy, alcoholic neuropathy, medication-induced neuropathy, fibromyalgia, and others -> see our education module!
  • Skin biopsy is a safe procedure with minimal discomfort that allows somatic fibers carrying temperature and pain sensation to be differentiated from autonomic fibers.
  • Loss of epidermal nerve fibers correlates with increased severity of neuropathy and a higher risk of developing neuropathic pain.
  • Skin nerve fibers are able to regenerate, and their regrowth rate could be a marker of early axonal damage in patients at risk of developing peripheral neuropathy.
  • A skin biopsy can be repeated in close proximity to a previous biopsy in order to assess the progression of neuropathy and the response to neuroprotective treatments and can be used as a measure of outcome in clinical trials.
Small Fiber Neuropathy

Small-Fiber Neuropathy Getting Bigger was the title of an article printed in the March 2016 edition of Muscle and Nerve (2). This is the most prestigious journal in peripheral neuropathy in the world. The article cites that hundreds of thousands of patients may suffer from this condition and it is only going to get worse.

What's The Cause of SFN?

The main causes are diabetes, pre-diabetes, and metabolic syndrome (3). SFN is the first finding for neurological sequela of diabetes (6,7).

New Gold Standard For Diagnosing SFN

Arrows indicate epidermal nerve fibers. The density of epidermal nerve fibers is reduced. ENFD testing is the most sensitive test to diagnosis small-fiber neuropathy!

ENFD Testing With Nova Labs

The skin test is brief, simple, and effective. The skin is numbed with an anesthetic after which a 3mm punch is used to remove a biopsy from the patient. The site is generally covered with a band-aid. This test takes roughly 5 minutes from start to finish.

What Can Nova Labs Do For You?

At NovaLabs we provide kits and shipping at no charge. We also provide on-site training for biopsy removal, packaging, and shipment. Our expert staff and board certified pathologists will be available for consultation to answer all your lab and patient related questions. Through our cutting edge test, you will be able to diagnose one of the major causes of chronic pain. It will allow you to not only diagnosis, but assess treatment efficacy!

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What Can Nova Labs Do For You?
Whats The Cause Of SFN

Our Company

  • NovaLabs is a leading histopathology lab designed to assist our physicians and patients in diagnosing small nerve peripheral neuropathy.
  • Located in Templeton California, NovaLabs offers a nationwide lab whose mission is to better assist providers in specimen referral and turnaround times.
  • At NovaLabs, it is our goal is to facilitate in faster reporting times and better outcomes for patients. Our services can reduce overall healthcare costs, unnecessary surgeries, unnecessary treatments and improve patient care.

Our Team

We’d like you to meet some talented people. The Nova Labs team pushes each other to be better, tackling challenges together and finding new and better ways of doing things. It is our goal to help you take the next step in caring for small-fiber neuropathy!

Education & Research

  • Specializing in you – the physician. You specialize in your patients; we specialize in you. That’s why you can count on us to deliver the best product and specialized education.
  • We offer in-office and staff training for the biopsy procedure, packaging, and shipment.
  • We offer comprehensive education modules for both patients and healthcare professionals.
  • Interested in ENFD testing to assess the progression of neuropathy and the response to your treatments, we are happy to help use ENFD testing as a measure of outcome on clinical trials.

Physician Education

Training Videos

Medical Literature

Patient Education


  1. Lauria G, Devigili G. Skin biopsy as a diagnostic tool in peripheral neuropathy. Neurology 2007. 3(10):546-557.
  2. Chan, Amanda C.y., and Einar P. Wilder-Smith. “Small Fiber Neuropathy: Getting Bigger!” Muscle & Nerve Muscle Nerve 53.5 (2016): 671-82
  3. Sumner, C.j., S. Sheth, J.w. Gri n, D.r. Cornblath, and M. Polydefkis. “The Spectrum of Neuropathy in Diabetes and Impaired Glucose Tolerance.” Neurology 60.1 (2003): 108-11. Print.
  4. Caro, Xavier J., and Earl F. Winter. “Evidence of Abnormal Epidermal Nerve Fiber Density in Fibromyalgia: Clinical and Immunologic Implications.” Arthritis & Rheumatology 66.7 (2014): 1945-954. Print.
  5. Levine, Todd D., and David S. Saperstein. “Routine Use of Punch Biopsy to Diagnose Small Fiber Neuropathy in Fibromyalgia Patients.” Clin Rheumatol Clinical Rheumatology 34.3 (2014): 413-17. Print.
  6. 6. Javed, S., I.n. Petropoulos, M. Tavakoli, and R.a. Malik. “Clinical and Diagnostic Features of Small Fiber Damage in Diabetic Polyneuropathy.” Diabetes and the Nervous System Handbook of Clinical Neurology (2014): 275-90. Print.
  7. Ziegler, D., N. Papanas, A. Zhivov, S. Allgeier, K. Winter, I. Ziegler, J. Bruggemann, A. Strom, S. Peschel, B. Kohler, O. Stachs, R. F. Gutho, and M. Roden. “Early Detection of Nerve Fiber Loss by Corneal Confocal Microscopy and Skin Biopsy in Recently Diagnosed Type 2 Diabetes.” Diabetes 63.7 (2014): 2454-463. Print.