Cutaneous Nerve Laboratory

The Johns Hopkins Cutaneous Nerve Laboratory was established in 1993 and was the first CLIA certified laboratory to use epidermal nerve fiber analysis as a diagnostic tool. The laboratory has been at the forefront of assessing the diagnostic and prognostic value of skin biopsies in neurological disease. We now offer these tests as a clinical service to all physicians.

Physicians: Order test kit and download forms

Patients: Learn about skin biopsy

photo of the tools needed to perform a skin punch procedure

Physicians: Watch a skin biopsy video

The lab provides diagnostic services to identify and monitor small fiber neuropathies through skin samples. Minimally-invasive 3mm skin punch specimens are analyzed for epidermal nerve fiber density and morphological changes.

What can skin biopsies detect?

Abnormal epidermal nerve fiber innvervation
Severity of neuropathy at sites not easily tested through electrophysiology
Abnormal nerve fiber morphology which can predict development of neuropathy
A pathological alternative in settings where electrophysiology is not available
Distinguish neuropathy from other causes of pain

Our laboratory offers:

Assessment of intraepidermal nerve fiber density
Evaluation of sweat gland innervation
Pathological review of all specimen by neuromuscular trained specialists
Rapid turnaround of results, typically less than 7 days from the time the sample is received
Biopsy kits with tools and return shipping

Our comprehensive diagnostic services are offered to both practicing physicians and patients.

Biopsies can be performed at physicians offices and then sent to the cutaneous nerve lab, or at the Johns Hopkins Outpatient Center or the Johns Hopkins Bayview Medical Center. In both situations, our staff will secure the patient's insurance authorization once the appropriate referral forms have been completed. If a physician wants to perform the biopsy at his or her office, a biopsy kit can be mailed once the patient's insurance authorization is obtained.