Clinical Utility of Skin Biopsy in Differentiating between Parkinson’s Disease and Multiple System Atrophy

Figure 2

Intraepidermal nerve fiber density in patients with multiple system atrophy (MSA) and patients with Parkinson’s disease (PD). ((a) and (b)) Confocal digital images showing a decrease in intraepidermal nerve fiber density in Parkinson’s disease (a) compared with multiple system atrophy (b). Nerve fibers and fibroblasts are labeled by PGP-9.5 (in green) and the basement membrane of the skin is labeled by collagen IV (in red; arrowheads). The number of nerve fibers penetrating the basement membrane (arrows) was quantified. (c) Intraepidermal nerve fiber density in patients with multiple system atrophy (MSA) and patients with Parkinson’s disease (PD). Fiber density is expressed as the number of counted nerves per linear millimeter at the basement membrane. Fiber density was significantly decreased in patients with PD compared with those with MSA. Error bars show standard error of the mean. (d) Intraepidermal nerve fiber density in patients with PD exposed to levodopa (levodopa+) and those naïve to levodopa (levodopa−). No significant difference was observed between two groups. IENFD: intraepidermal nerve fiber density; MSA: multiple system atrophy; PD: Parkinson’s disease.

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