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Review
. 2013 Jan;47(1):1-11.
doi: 10.1002/mus.23510. Epub 2012 Nov 28.

Evaluating dermal myelinated nerve fibers in skin biopsy

M Iliza Myers  1 , Amanda C Peltier, Jun Li
Affiliations
Review

Evaluating dermal myelinated nerve fibers in skin biopsy

M Iliza Myers et al. Muscle Nerve. 2013 Jan.

Abstract

Although there has been extensive research on small, unmyelinated fibers in the skin, little research has investigated dermal myelinated fibers in comparison. Glabrous, nonhairy skin contains mechanoreceptors that afford a vantage point for observation of myelinated fibers that have previously been seen only with invasively obtained nerve biopsies. This review discusses current morphometric and molecular expression data of normative and pathogenic glabrous skin obtained by various processing and analysis methods for cutaneous myelinated fibers. Recent publications have shed light on the role of glabrous skin biopsy in identifying signs of peripheral neuropathy and as a potential biomarker of distal myelin and mechanoreceptor integrity. The clinical relevance of a better understanding of the role of dermal myelinated nerve terminations in peripheral neuropathy will be addressed in light of recent publications in the growing field of skin biopsy.

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Figures

Figure 1
Figure 1
Schematic of neural structures present in glabrous skin and hairy skin. Small sensory fibers branch off of dermal bundles to innervate the epidermis in both hairy and glabrous skin. In addition, autonomic nerve fiber innervation can be seen in sweat glands and arrector pili muscles. The presence of large myelinated fibers in hairy skin is largely restricted to mechanoreceptive hair follicles; glabrous skin has a comparatively high density of mechanoreceptive organs and afferent Aβ caliber myelinated fibers.
Figure 2
Figure 2
Confocal images of MBP-immunoreactive myelinated fibers in hairy (A) and glabrous skin (C). In glabrous skin, fibers are prevalent and homogenously spaced as they furnish Meissner corpuscles in the dermal papillae (D). In hairy skin, MBP-ir fibers are typically much less prevalent and frequently cluster around hair follicles (B).
Figure 3
Figure 3
Immunohistochemical analysis of glabrous skin biopsies has been shown to reveal shortened internodal lengths in patients with CMT1A (B) and CIDP (C) compared to controls (A). Additionally, CIDP patients had signs of segmental demyelination in the paranodal regions, designated by the absence of Myelin Basic Protein staining (C, arrowheads).
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