Punch Biopsy for Small Fibre Neuropathy (SFN)
A punch biopsy for small fibre neuropathy is a simple procedure that involves taking a small, circular sample of skin to assess the health of tiny nerve fibres and confirm a diagnosis of small fibre neuropathy.
What is a punch biopsy for small fibre neuropathy?
Small fibre neuropathy (SFN) is a type of peripheral neuropathy that affects the small nerve fibres in the skin. These nerve fibres are responsible for sensing pain and temperature, and some also play a role in regulating involuntary body functions such as heart rate, blood pressure, sweating, and digestion.
When these small nerve fibres are damaged, symptoms can develop. These often include burning pain, tingling, numbness, or altered sensation in the hands and feet. Some people may also experience symptoms linked to the autonomic nervous system, such as lightheadedness, heart palpitations, digestive problems, or changes in sweating.
A punch biopsy is one of the only tests that can directly assess these small nerve fibres. During the test, a small sample of skin is taken and sent to a specialist neurological laboratory. The laboratory measures the number of small nerve fibres present in the outer layer of the skin. A reduced nerve fibre density can help confirm a diagnosis of SFN.
At Welbeck, our consultant neurologists have extensive experience in diagnosing and managing SFN. Your punch biopsy will be carried out by a consultant dermatologist in our outpatient Skin Health clinic, with care focused on comfort, clear communication, and accurate results to help guide the next steps in your care.
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We offer appointments to paediatric patients aged 3+. For full information on our paediatrics service, please visit our main Paediatrics page.
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Your punch biopsy will be carried out in one of our comfortable procedure rooms in our outpatient clinic. You may be asked to change into a gown before the procedure, depending on the biopsy site.
Your consultant will begin by gently injecting a small amount of local anaesthetic to fully numb the area being sampled before the biopsy. Once the skin is numb, a small, round-tipped cutting tool is placed onto the skin at a right angle and gently rotated. This creates a small circular sample that includes the superficial and slightly deeper layers of the skin.
The incision is very small, and in most cases, only 1 or 2 fine stitches are needed to close the wound. A small dressing is then applied to keep the site clean and dry while it heals.
The procedure is quick and straightforward, usually taking just 5 to 10 minutes, and you’ll be able to go home soon after. The sample will be sent to a laboratory for analysis, and your consultant will arrange a follow-up appointment to explain the results and discuss your ongoing care.
A punch biopsy is considered a very low-risk procedure, and most people recover without any problems. However, as with any medical procedure, there are some potential risks.
These can include:
bleeding from the biopsy site, which usually settles with pressure
mild pain or tenderness as the local anaesthetic wears off
infection at the biopsy site, which is uncommon, but may need treatment with antibiotics
scarring – usually a small straight-line scar which will fade over time
No specific preparation is needed before having a punch biopsy. You should continue to eat, drink, and take any medications as normal unless advised otherwise by your consultant. If the biopsy is being taken from an easily accessible area, such as the arm or leg, it’s helpful to wear loose clothing that can be easily rolled up.
You may feel some tenderness or numbness around the site for a few days and have mild bruising, which is normal. You’ll be given information on how to care for the wound at home and when any stitches will need to be removed. You can usually return to light daily activities straight away, but your consultant will give you specific advice on this, depending on the site.
Bleeding can usually be managed by applying firm pressure to the area for 10 to 15 minutes. If the biopsy is taken from a limb, keeping the area raised can also help. Mild redness around the stitches is normal, but increasing pain, swelling, redness, or discharge may indicate an infection. Your clinical team will explain what to look out for and how to contact them if you have any concerns after the procedure.
You should keep the wound clean and dry and avoid baths and strenuous activity while the wound is healing. It typically takes 2 to 3 weeks for the biopsy site to heal completely. Following the procedure, you’ll be left with a small straight-line scar, usually around 4mm to 8mm in length, which will usually reduce in colour and size over several months.
Please contact our Neurology centre for pricing information.
At Welbeck, our neurologists are experts in their field and are dedicated to providing world-class care to every patient.
With access to colleagues across other specialties, our consultants are also able to refer within the Welbeck ecosystem if required to ensure you receive the treatment you need as quickly as possible, all under one roof.
All appointments, testing, treatment, and follow-up appointments take place within our state-of-the-art facilities, enabling us to deliver accurate diagnostics and advanced treatments.
To book a punch biopsy for small fibre neuropathy, you must be referred by either your GP or a neurologist following a consultation with them. Self-referrals are not accepted for this treatment.
If you’d like to schedule a consultation with a neurologist, please get in touch to make an appointment. Your health is important to us, so we strive to offer same-day appointments whenever possible.
Our consultants are recognised by the major health insurance companies. If you have private health insurance, your treatment at Welbeck can begin once you have obtained authorisation. We also provide care to self-paying patients. type: entry-hyperlink id: 1YuZ3V279a2oXY1AQY67BC about the different payment options at Welbeck.
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Frequently asked questions
Small fibre neuropathy affects nerves that aren’t easily assessed with other tests, such as standard nerve conduction studies. A punch biopsy allows direct measurement of the small nerve fibres in the skin, making it the most reliable way to confirm a diagnosis.
In most cases, you can drive yourself home immediately after the procedure, as only a small area is numbed. However, if the biopsy is performed near a joint — such as on your hand or foot — or if you feel any discomfort or stiffness, it’s best to arrange for someone else to drive. Your consultant will advise you based on your biopsy site.
The biopsy sample is sent to a specialist neurological laboratory for analysis. Your consultant will let you know when results are expected (usually within 20 working days), and will arrange a follow-up appointment to discuss them as soon as possible once they’re available.
At Welbeck, our consultant neurologists have extensive experience in managing small fibre neuropathy. If a diagnosis is confirmed, your consultant will explain the results clearly and talk through what they mean for your symptoms and everyday life. Where appropriate, further tests may be arranged to look for underlying causes, and your care will be coordinated with other Welbeck specialists to create a personalised management plan, with ongoing support at every stage.