In small fibre neuropathy, intraepidermal nerves are reduced. Fibres are supposed to degenerate due to toxic or metabolic insults, but why do they not regenerate after the injury is gone? Which cues facilitate or inhibit epidermal re-innervation, and how the resulting changes of epidermal nerve fibres can contribute to pain? In this talk I will show how dysfunction of keratinocytes is in part the cause of lack of epidermal reinnervation, maintaining epidermal fiber damage, both in patients and in a preclinical model of small fiber neuropathy.