Patients with Sjögren’s disease may develop a small-fiber sensory neuropathy, manifested by sensations of burning and numbness in their hands and feet and occasionally in other portions of the body (such as the face, torso, and proximal extremities). A cutaneous nerve/skin biopsy is useful to diagnose the presence and stage the severity of such a neuropathy. This is a very simple procedure performed in the outpatient setting. It takes 10 to 15 minutes to complete. First, the skin is thoroughly cleaned and a small injection of a local anesthetic to numb the skin is made. Then, a sample of skin is taken by a biopsy from the numb area of the skin. A bandage dressing is used to cover the biopsy site. Generally, the skin heals easily within one to two weeks without the need for a suture. The risk of bleeding or infection is extremely low. The skin biopsy is examined by expert physicians in the Johns Hopkins Department of Neurology and assessed for the epidermal nerve fiber density and morphologic changes of the nerve fibers.
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