Related Experiment Video
Updated: Jun 23, 2026
Three-dimensional Imaging of Nociceptive Intraepidermal Nerve Fibers in Human Skin Biopsies
Published on: April 29, 2013
Stimulated skin wrinkling for predicting intraepidermal nerve fibre density
Einar P Wilder-Smith1, Yaling Guo, Adeline Chow
1Division of Neurology, National University Singapore, 5 Lower Kent Ridge Road, Singapore 119074, Singapore. mdcwse@nus.edu.sg
Objective:
To determine the usefulness of stimulated skin wrinkling using EMLA and water immersion in detecting abnormal intraepidermal nerve fibre density.
Methods:
In a prospective study of patients with predominantly sensory polyneuropathy, we tested sensitivity and specificity of stimulated skin wrinkling using EMLA and water immersion in detecting abnormal intraepidermal nerve fibre density (IENFD).
Results:
EMLA stimulated wrinkling showed a sensitivity of 81.6% and specificity of 74.7% in detecting abnormal IENFD and water wrinkling a sensitivity of 71.4% and specificity of 73%. The positive and negative predictive values for detecting abnormal IENFD were 88.3% and 63.3% for EMLA wrinkling, for water wrinkling 83.3% and 57.4%. Intra-observer EMLA score variability was good with no change in assignment of wrinkling and inter-observer score variability resulted in 1-5 changes in wrinkling score which translated into a change of the wrinkling status from normal to abnormal on two occasions.
Conclusions:
Stimulated skin wrinkling correlates well with abnormal intraepidermal nerve fibre density.
Significance:
Our study suggests that EMLA induced stimulated skin wrinkling is a useful alternative parameter for predicting abnormal intraepidermal nerve fibre density.
More Related Videos
Related Concept Videos
01:16Sensory Functions of the Skin
There are two main categories of receptors on the skin: capsulated and non-capsulated. The non-capsulated ones are mainly the pain receptors. The capsulated ones can be further categorized based on the...
01:15Reticular Dermis
Reticular Layer
Underlying the papillary layer is the much thicker reticular layer, composed of dense, irregular connective...
01:11Papillary Dermis
The dermis might be considered the "core" of the integumentary system, as distinct from the epidermis and hypodermis. It contains blood and lymph vessels, nerves, and other structures, such as hair follicles and sweat glands. The dermis is made of two layers of connective tissue that comprise an interconnected mesh of elastin and collagenous fibers, produced by fibroblasts.
Papillary Layer
The papillary layer is made of loose, areolar connective tissue, which means the collagen and...
01:24Local Anesthetics: Differential Sensitivity of Nerve Fibers