Nerve Fiber
Density Testing

Epidermal Nerve Fiber Density (ENFD) Testing offers a powerful tool for small fiber peripheral neuropathy documentation

What is
Small Fiber

Small Fiber Neuropathy (SFN) impacts the small, unmyelinated nerve fibers in the skin and organs. This condition is commonly caused by diabetes or glucose intolerance. Symptoms include tingling, numbness, burning, or prickling sensations in the feet, which may gradually spread upward. It is crucial to diagnose this condition early to determine the root cause.

What is Epidermal
Nerve Fiber
Density (ENFD)




A Powerful Tool

The Epidermal Nerve Fiber Density (ENFD) Test offers a powerful tool for small fiber peripheral neuropathy documentation.


Direct Visualization

This test enables direct visualization and quantification of the terminal branches within the skin of a peripheral nerve.


Gauge Health

The structural integrity of the small nerve fibers is assessed. Then, they are counted to gauge the health of the nerves.


Nerve Fiber Count

A decrease in the number of small nerve fibers indicates the presence of established diseases, and the severity escalates as the count decreases

Why ENFD Testing?

Diagnosing and treating Small Fiber Neuropathy requires ENFD testing, which is critical. This test helps us develop personalized treatment plans, avoid unnecessary procedures, and ultimately improve patient care while reducing healthcare costs. Moreover, it can prevent severe complications such as amputations.

Who is Eligible ?

Individuals living with pre-diabetes, diabetes, fibromyalgia, auto-immune diseases, or other metabolic conditions should consider undergoing testing for small fiber neuropathy (SFN). Moreover, individuals experiencing symptoms such as pain, numbness or tingling sensations, irregular blood pressure, or disruptions in coordination or balance are also suitable candidates for this test.


The ENFD Test is
Crucial in Diagnosing
Conditions Related to
Small Fiber Neuropathy

  • Metabolic Conditions: This category includes ailments such as diabetes mellitus, metabolic syndrome, and hyperlipidemia.
  • Inherited Disorders: Conditions that are passed down through generations, like Fabry's disease, Tangier's disease, and familial amyloid polyneuropathy, fall under this category.
  • Toxic Triggers: Exposure to harmful substances, such as those experienced during chemotherapy, from alcoholism, or due to solvent exposure, can lead to the development of the disease.
  • Autoimmune Diseases: Certain autoimmune conditions like Sjögren's syndrome and vasculitis/polyarteritis nodosa can lead to small fiber peripheral neuropathy.
  • Amyloidosis includes non-inherited forms of amyloidosis, for example, those linked with lymphoma or plasma cell dyscrasias.
  • Infectious Causes: Some infectious diseases, like HIV, hepatitis C, and Lyme disease, can also lead to the development of small fiber peripheral neuropathy.
  • Idiopathic Cases: A significant number of cases have no identifiable cause of small fiber peripheral neuropathy and are categorized as idiopathic.

How it works

  • Order your Mammoth Dx biopsy kit
  • Apply anesthesia around the biopsy site
  • Use the provided 3mm punch biopsy instrument to perform the biopsy
  • Use the provided 3mm punch biopsy instrument to perform the biopsy

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