Friday, September 23rd
10:45am-12:15pm EDT


Topical Workshop


Novel Experimental/Analytic Approaches/Tools


714 A

Taking, Processing, Analyzing, Learning: Skin Punch Biopsies – More Than Just Fiber Count

One histological hallmark of neuropathies is loss of intraepidermal nerve fibers, as shown by skin punch biopsy from the distal and proximal leg. While the procedure is fast and simple, even small but strategic inaccuracies may lead to clinically relevant misinterpretations. Following standardized guidelines for processing and analyzing skin samples is mandatory to ensure accurate data. Advance in methodology has carried skin biopsies far beyond the mere determination of nerve fiber density. It is, for example, possible to distinguish between somatosensory and autonomic nerve fibres, to assess sweat gland innervation and quantify morphological abnormalities of the nerve fibers such as axonal swellings, and to identify nerve fiber subtypes positive for calcitonin gene-related peptide (CGRP) or substance P. Skin punch biopsy also allows the investigation of other cells such as keratinocytes, Langerhans cells, inflammatory cells, as well as the most recent example of ‘nociceptive’ Schwann cells. This workshop will teach the audience how to accurately obtain, process, and analyse skin punch biopsies for clinical and research purposes using short presentations, live demonstrations, pre-recorded videos, and on-stage microscopy.


10:45am EDT12:15pm EDT

Clinical and Research Aspects of Skin Biopsies

Tracks: Novel Experimental/Analytic Approaches/Tools
Categories: Topical Workshop
Presented By: Roy Freeman

In this presentation, skin punch biopsy as a powerful tool in clinical practice and basic science will be introduced. Based on skin anatomy, potential areas of application will be discussed keeping a critical view on every step of the procedure and highlighting the advantages as well as the challenges and limits of the method.

10:45am EDT12:15pm EDT

How To Stain And Analyze Skin Biopsies With Traditional And Unconventional Biomarkers

Tracks: Novel Experimental/Analytic Approaches/Tools
Categories: Topical Workshop
Presented By: Dr. Eleonora Galosi

Guidelines on the use of skin biopsy in clinical practice have never described in detail how immunohistological staining process and microscopy analysis of skin samples should be performed. Although a consensus on these technical issues has been reached among highly referenced skin biopsy laboratories, a wide inter-laboratory variability in procedures still exists, conditioning skin biopsy diagnostic accuracy in a clinical setting and results heterogeneity in research. In order to highlight in a simple way the most widely accepted procedures, Eleonora will step-by-step describe the staining process through bright field immunohistochemistry and indirect immunofluorescence with PGP 9.5 via pre-recorded video and short presentation. Through a light microscope with attached camera (or alternatively histological images video-library) she will give a practical demonstration of intraepidermal nerve fibers counting, providing useful tips to carry out a correct intraepidermal nerve fibre density calculation. She will then show how to approach a semiquantitative assessment of autonomic innervation of piloerector muscle and sweat gland stained by PGP 9.5. Slides marked with alternative sensory biomarkers such as Growth associated protein 43 and TRPV1, nowadays principally used in a research setting, will also be shown and discussed.

10:45am EDT12:15pm EDT

How to Take and Process a Skin Biopsy Following Published Guidelines

Tracks: Novel Experimental/Analytic Approaches/Tools
Categories: Topical Workshop
Presented By: Dr. Pall R. Karlsson
The pathological hallmark in patients with painful neuropathies is a significant loss of intraepidermal nerve fibers (IENF density).

While the skin biopsy procedure is fast and relatively simple, it is easy to make small but paramount mistakes. Additionally, it is imperative that laboratories who process and analyze skin punch biopsies follow published standardized guidelines to secure results of high accuracy and quality. There is an urgent need to take steps helping to secure laboratories around the world follow published guidelines in order to secure high quality results and homogeneity in methods. In this presentation, Páll Karlsson will, via pre-recorded video and short presentation, describe the dos and don´ts when taking skin biopsies and the subsequent treatment, making it ready for immunohistological staining.


Roy Freeman

Beth Israel Deaconess Medical Center and Harvard Medical School

Dr. Eleonora Galosi

“La Sapienza” University

Dr. Pall R. Karlsson

Associate professor
Aarhus University