Dermal sheet preparations in the evaluation of dermal innervation in Parkinson’s disease and multiple system atrophy


  • Current address: Peter Novak, Department of Neurology, University of Massachusetts Medical School, Worcester, MA, USA.

Jag Bhawan, MD, Dermatopathology Section, Department of Dermatology, Boston University School of Medicine, 609 Albany Street, J-309, Boston, MA 02118, USA
Tel: (617) 638 5570
Fax: (617) 638 5575


Background:  Evaluation of dermal nerve fibers in conventional vertical sections is difficult because of the small number of fibers available for examination. In this study, we evaluated dermal sheet mounts for fibers in which the majority of fibers can be visualized.

Methods:  We compared the dermal small fiber density in six Parkinson’s disease (PD) and six multiple system atrophy (MSA) patients using dermal sheet preparations (DSP). DSP are based on epidermal-dermal separations and immunostaining of the entire dermis by the nerve growth factor receptor p75 antibody that stains both autonomic and sensory fibers.

Results:  The small fiber density was reduced in PD compared with MSA (p < 0.0001), suggesting the presence of small fiber neuropathy in PD.

Conclusions:  DSP offer a unique method of evaluation of dermal nerve fibers. This method can be used to evaluate small nerve fibers in many neurological disorders such as MSA and PD.