Functional Medicine Tips for Skin Health & Inflammation

Discover how functional medicine can address skin health from inflammation and promote a healthier lifestyle.

Abstract

In our ongoing commitment to comprehensive, integrative health education, this post explores the common dermatological condition known as seborrheic keratosis. While these growths are typically benign, they can sometimes become inflamed, painful, or change in appearance, prompting a closer clinical evaluation. Today, I want to guide you through the diagnostic process for this skin lesion, focusing on the shave skin biopsy—a minimally invasive, highly effective procedure used to obtain a tissue sample for pathological analysis. We will explore the step-by-step technique, from local anesthesia to hemostasis, and explain the clinical reasoning behind each step. This discussion will also highlight the collaborative, multidisciplinary approach we employ at Injury Medical Clinic, where my expertise in functional and integrative care works in synergy with the medical oversight of our esteemed Medical Director, Dr. Maria Guadalupe Cardenas, MD. Our goal is to demystify this common procedure by showing how modern, evidence-based methods fit into a patient-centered care model that prioritizes accurate diagnosis and patient comfort.

A Collaborative Approach to Patient Care in El Paso, TX

Before we dive into today’s topic, I want to explain the unique structure of our practice, Injury Medical Clinic PA, here in El Paso, Texas. My journey in healthcare has led me to earn a diverse set of credentials—from Doctor of Chiropractic (DC) to Advanced Practice Registered Nurse and Board-Certified Family Nurse Practitioner (APRN, FNP-BC), along with multiple certifications in functional medicine (CFMP, IFMCP). This background allows me to view health through multiple lenses, integrating chiropractic principles with a broader understanding of systemic health.

However, true comprehensive care often requires a team. That is why I am privileged to work alongside Dr. Maria Guadalupe Cardenas, MD, our Medical Director and Collaborative Physician. Dr. Cardenas is a highly respected internist, board-certified in Internal Medicine, with over 40 years of invaluable clinical experience. Her deep knowledge of internal medicine provides the essential medical oversight that anchors our practice.

This multidisciplinary model is the cornerstone of our philosophy. Here’s how it works:

• Integrated Expertise: My role often involves functional diagnostics, chiropractic adjustments, rehabilitation, and managing complex cases from a systems-biology perspective. Dr. Cardenas provides crucial medical direction, oversees treatment plans, prescribes medications when necessary, and ensures all care aligns with the highest standards of medical practice.
• Patient-Centered Protocols: When a patient presents with an issue outside the traditional scope of chiropractic or functional medicine—such as a suspicious skin lesion requiring a biopsy—our collaborative structure ensures they receive appropriate, timely medical care in a familiar, trusted environment.
• Comprehensive Services: This synergy allows us to offer a wide spectrum of services under one roof, including chiropractic care, personal injury rehabilitation, functional medicine, and primary care procedures. A patient might see me for spinal decompression and nutritional counseling, while also having Dr. Cardenas manage their hypertension or perform a necessary medical procedure.

Our shared goal is to provide seamless, evidence-based care that addresses the whole person. This collaborative framework ensures safety, efficacy, and integrated care that truly benefits our patients’ health journeys.

Understanding Seborrheic Keratosis: The “Barnacles of Aging”

Let’s turn our attention to the clinical scenario at hand. We recently saw a middle-aged gentleman in our clinic with a specific concern: a skin lesion on the lateral aspect of his right hip. He said it had become more noticeable over the past four weeks, with inflammation and pain. On clinical examination, the lesion showed the classic features of an inflamed seborrheic keratosis.

Seborrheic keratoses (often pluralized as keratoses) are some of the most common noncancerous skin growths in older adults. They often have a waxy, scaly, and slightly elevated appearance. They can vary in color from light tan to brown or black and are sometimes colloquially referred to as “barnacles of aging” because they tend to accumulate on the skin as we get older.

Key Characteristics of Seborrheic Keratosis:

• Appearance: They can look like a dab of brown or black candle wax was dropped on the skin. They often have a “stuck-on” appearance.
• Texture: The surface is typically waxy, scaly, or slightly bumpy.
• Location: They can appear anywhere on the body except for the palms and soles. They are most common on the chest, back, stomach, scalp, face, and neck.
• Benign Nature: Crucially, these growths are benign, meaning they are not cancerous and do not become cancerous.

Why Does Seborrheic Keratosis Become Inflamed?

While seborrheic keratoses are harmless, they can become a source of irritation or concern for several reasons. The primary cause of inflammation is usually physical friction. Because they are raised, they can easily be rubbed or irritated by clothing, seatbelts, or even just routine movement. This constant friction can lead to:

• Inflammation: The surrounding skin can become red and tender.
• Pain: The lesion itself may become sore to the touch.
• Bleeding: If scratched or rubbed aggressively, the growth can bleed.
• Changes in Appearance: Inflammation can cause the lesion to enlarge, change color, or develop a crust, which can sometimes make it difficult to distinguish from more serious skin conditions, like melanoma, based on visual inspection alone.

In our patient’s case, the location on his lateral hip is a common site for friction from his waistband. This likely explains the recent onset of inflammation and pain he was experiencing.

The Importance of a Definitive Diagnosis: Why a Biopsy is Necessary

Although the clinical presentation strongly suggested an inflamed seborrheic keratosis, a core principle in medicine is never to assume. When a skin lesion changes rapidly, becomes painful, bleeds, or looks atypical, we must obtain a definitive diagnosis. The “old standard” is a skin biopsy, where a small tissue sample is removed and sent to a pathologist for microscopic examination.

A biopsy serves two critical purposes in this scenario:

1. Confirmation: It confirms our clinical suspicion. If it is indeed a seborrheic keratosis, the patient can be reassured that the growth is benign.
2. Exclusion: More importantly, it rules out malignancy. While rare, certain forms of skin cancer, such as basal cell carcinoma or even melanoma, can sometimes mimic the appearance of an irritated seborrheic keratosis. A pathological analysis is the only way to be 100% certain.

Given the recent enlargement and inflammation our patient was experiencing, proceeding with a biopsy was the most prudent and responsible course of action. It aligns with our commitment to evidence-based practice and patient safety.

The Shave Biopsy: A Detailed Walkthrough of the Procedure

For a raised lesion like a seborrheic keratosis, the preferred biopsy method is often a shave biopsy. This technique is minimally invasive, quick, and highly effective for sampling superficial lesions. It involves using a sharp blade to “shave” off the growth at the level of the surrounding skin.

I want to take you through the exact steps we followed, explaining the rationale behind each one. Our primary goals in any procedure are patient comfort, procedural effectiveness, and safety.

Step 1: Skin Preparation and Initial Anesthesia

The first step in any minor surgical procedure is to prepare the area to minimize infection risk.

• Cleansing the Site: I began by thoroughly cleaning the skin over and around the lesion with an alcohol pad. This process, known as antisepsis, removes surface bacteria and debris, creating a clean field for the procedure.
• Topical Anesthetic Spray: The most common source of anxiety for patients undergoing a biopsy is the initial needle stick for the local anesthetic. To mitigate this discomfort, I used a topical vasoconstrictor spray called Pain-Ease Mist. This spray rapidly cools the skin surface. The intense cold temporarily numbs superficial nerve endings, distracting the brain from the needle prick. It’s a simple but incredibly effective technique for improving the patient experience. I applied a brief spray directly to the target area just moments before the injection.

Step 2: Injecting the Local Anesthetic—The Two-Phase Technique

With the surface numbed, the next step was to administer a local anesthetic to ensure the entire area was pain-free for the biopsy itself. For this, I used 1% lidocaine with epinephrine.

Let’s break down this choice:

• Lidocaine: A fast-acting local anesthetic that blocks sodium channels in nerve fibers. When sodium cannot enter nerve cells, they can’t depolarize and send a pain signal to the brain. This creates a profound numbing effect in the targeted tissue.
• Epinephrine: This is a vasoconstrictor, meaning it causes the small blood vessels in the area to narrow. Adding epinephrine to the lidocaine serves two vital purposes:

1. Prolongs the Anesthetic Effect: By constricting blood vessels, it slows down the rate at which the lidocaine is absorbed into the bloodstream and carried away from the injection site. This keeps the anesthetic concentrated in the target tissue longer, ensuring the area remains numb throughout the procedure and for some time afterward.
2. Provides Hemostasis: The vasoconstriction also significantly reduces bleeding during and after the procedure. This is especially important in a shave biopsy, which creates a superficial wound. A drier field makes the procedure easier to perform and minimizes post-procedural bleeding.

I used a very fine 30-gauge, half-inch needle to minimize injection discomfort. I injected two distinct phases for maximum effectiveness and comfort.

• Phase One: Subcutaneous Depot: I quickly inserted the needle into the subcutaneous tissue (the fatty layer just beneath the skin) adjacent to the lesion. Here, I injected about 1 mL of the lidocaine with epinephrine solution. This creates a “depot” or reservoir of anesthetic deep to the lesion. This numbs the deeper nerves in the area and provides a foundational level of anesthesia. When I asked the patient, “Does that hurt?” he answered, “No,” confirming the initial vapocoolant spray was effective. I then allowed the anesthetic a moment to begin taking effect.
• Phase Two: Creating the Intradermal Wheal: This is the most crucial part of the anesthetic injection for a shave biopsy. Without pulling the needle completely out of the skin, I carefully redirected it horizontally and advanced it intradermally—directly within the top layer of the skin, just underneath the lesion. As I slowly injected more of the anesthetic solution into this space, a visible, raised, pale bump called a wheal began to form.

You could see the skin puff up, and this intradermal wheal serves a brilliant dual purpose:

1. Profound Anesthesia of the Lesion: By injecting the anesthetic directly beneath the lesion, we ensure that the exact tissue we are about to remove is completely numb. The patient confirmed this again, stating he felt no stinging, which attests to the initial subcutaneous block taking effect.
2. Mechanical Elevation of the Lesion: This is the elegant part of the technique. The injection fluid physically lifts the lesion up and away from the deeper skin layers. It essentially “presents” the lesion to us on a platter, making it much easier to access and shave off cleanly and evenly. It creates a firm, elevated platform to work on, which improves the quality and precision of the biopsy.

Step 3: Performing the Shave Biopsy

Once the wheal was fully developed and the area was confirmed to be completely numb, it was time to perform the biopsy.

• Tool of Choice: For a shave biopsy, we typically use a sterile, flexible razor blade or a specialized tool called a DermaBlade. The goal is to use a very sharp instrument to achieve a clean, smooth cut.
• The Technique: I began the shave about two millimeters lateral to the lesion. This ensures the initial cut is in normal, healthy skin, allowing a clean entry. I held the blade parallel to the skin surface and used a smooth, sweeping, saw-like motion to pass it horizontally through the dermis, directly beneath the lesion. The intradermal wheal created a taut surface, which is critical for preventing the blade from digging too deep or skipping.
• Ensuring a Complete Sample: My goal was to remove the entire visible lesion in one piece. I continued the motion all the way through to the other side of the growth. A proper shave biopsy should include the full thickness of the epidermis and a portion of the superficial dermis. This ensures the pathologist has enough tissue to make an accurate diagnosis. After the pass was complete, a visual inspection confirmed that no visible lesion remained. The resulting wound is a very shallow, circular or oval-shaped graze, similar to a deep scrape.

Step 4: Achieving Hemostasis

Immediately after tissue removal, the superficial capillaries in the dermis begin to bleed. The final, critical step is to stop this bleeding, a process known as hemostasis. While the epinephrine in the anesthetic helps significantly, an additional hemostatic agent is almost always required.

• Agent of Choice: Aluminum Chloride: For superficial wounds like this, my preferred agent is aluminum chloride (e.g., Drysol). This powerful chemical styptic agent works by precipitating proteins in the blood and surrounding tissue, mechanically plugging the cut ends of small capillaries.
• Application: I saturated a sterile gauze pad with the aluminum chloride solution and applied it to the biopsy site with firm, direct pressure. The pressure helps slow the bleeding, while the chemical agent creates a seal. After holding pressure for a minute or two, the bleeding stopped completely.
• Why Not Electrocautery? In some settings, a practitioner might use an electrocautery device to burn the bleeding vessels shut. While effective, I often prefer a chemical agent like aluminum chloride for shave biopsies because it avoids thermal damage to the surrounding tissue, which can sometimes result in a slightly more noticeable scar. For a simple, superficial wound, a chemical styptic is often sufficient and very effective.

Step 5: Dressing the Wound

With hemostasis achieved, the final step was to dress the wound.

• Sterile Packaging: We covered the site with a small amount of antibiotic ointment and a sterile adhesive bandage. We provided the patient with clear post-procedure instructions, which typically involve keeping the area clean and dry for the first 24 hours, then cleaning it daily and applying a fresh bandage until it heals, usually within one to two weeks.

The entire procedure, from the initial alcohol swab to the final bandage, took only a few minutes. It is a perfect example of a modern, efficient, and evidence-based medical procedure that provides immense diagnostic value with minimal patient discomfort or downtime.

The Healing Diet: Combat Inflammation, Embrace Wellness- Video

The Role of Integrative and Chiropractic Care in Overall Wellness

Now, you might be wondering, “Dr. Jimenez, you’re a chiropractor. How does performing a skin biopsy fit into your practice?” This is a fantastic question that gets to the very heart of my philosophy of care.

My training as a Family Nurse Practitioner (FNP-BC) and my extensive work in functional medicine (IFMCP) complement my chiropractic foundation. This integrative model recognizes that the human body is an interconnected system. While chiropractic care focuses brilliantly on the neuromusculoskeletal system—addressing spinal misalignments (subluxations), nerve impingement, and biomechanical function—our overall health is influenced by much more.

Here is how these fields intersect in our practice:

• A Gateway to Broader Health: Patients often first come to see me for back pain, neck pain, or sciatica. During our comprehensive examination and history-taking, other health concerns frequently come to light. The trust we build through effective chiropractic care makes patients comfortable discussing other issues, from digestive problems to skin lesions.
• Addressing Inflammation Systemically: In our patient with an inflamed seborrheic keratosis, the inflammation was localized due to friction. However, many patients suffer from chronic systemic inflammation, which can manifest in numerous ways, including joint pain, autoimmune conditions, and even certain skin disorders like psoriasis or eczema. As a functional medicine practitioner, I work to identify and address the root causes of this systemic inflammation through advanced diagnostic testing (e.g., food sensitivity panels, gut microbiome analysis) and targeted interventions like nutritional plans, supplementation, and lifestyle modifications.
• The Skin as a Window to Internal Health: The skin often reflects our internal health. Chronic skin issues can be linked to gut dysbiosis, nutrient deficiencies, hormonal imbalances, or toxic exposures. By integrating functional medicine, we can look beyond the surface symptom and investigate these underlying drivers. For example, improving gut health with specific probiotics and a low-inflammatory diet can profoundly improve skin health.
• Holistic Patient Management: Our practice model, with Dr. Cardenas’s medical direction, allows us to manage the whole patient. A patient receiving chiropractic adjustments for spinal health can simultaneously have a suspicious mole evaluated and biopsied, their blood pressure managed, and a functional medicine plan implemented to optimize their gut health. This eliminates the need for patients to navigate a fragmented healthcare system and see multiple disconnected specialists. It’s all part of one cohesive, personalized treatment plan.

By wearing these different hats—chiropractor, nurse practitioner, functional medicine expert—and collaborating closely with Dr. Cardenas, we can provide a level of care that is both broad in scope and deep in its approach to finding and fixing the root cause of dysfunction, whether it’s a spinal subluxation or an inflamed skin lesion.

Conclusion: The Power of an Integrated, Evidence-Based Approach

The simple case of an inflamed seborrheic keratosis and its management via a shave biopsy serves as a microcosm of our entire practice philosophy. It demonstrates a commitment to:

• Accurate Diagnosis: Using modern, evidence-based procedures to get definitive answers.
• Patient Comfort: Employing techniques to minimize pain and anxiety.
• Safety and Efficacy: Choosing the right tools and agents for the job, from anesthesia to hemostatic agents.
• Collaborative Care: Leveraging the combined expertise of a multidisciplinary team to provide comprehensive medical and functional care.

Ultimately, our goal is to be a trusted partner in your health journey. Whether you are dealing with chronic pain, a new and concerning symptom, or wish to optimize your overall wellness, our integrated model is designed to provide you with the answers, treatments, and support you need. The health journey is complex, but with a knowledgeable, collaborative team, it becomes a clear, manageable path.

References

• American Academy of Dermatology Association. (n.d.). Seborrheic keratoses: Diagnosis and treatment. Retrieved from https://www.aad.org/public/diseases/a-z/seborrheic-keratoses-treatment
• Goldman, L., & Belsito, D. V. (2020). Fitzpatrick’s dermatology (9th ed.). McGraw-Hill Education.
• Zuber, T. J. (2002). The shave biopsy. American Family Physician, 65(6), 1155-1158. Retrieved from https://www.aafp.org/pubs/afp/issues/2002/0315/p1155.html

SEO Tags: Seborrheic Keratosis, Shave Biopsy, Skin Lesion, Integrative Medicine, Chiropractic Care, Functional Medicine, Dr. Alex Jimenez, El Paso TX, Dr. Maria Cardenas, Local Anesthesia, Lidocaine with Epinephrine, Intradermal Wheal, Hemostasis, Aluminum Chloride, Dermatology Procedure, Patient-Centered Care, Multidisciplinary Clinic, Skin Health, Inflamed Skin Lesion, Biopsy Procedure

Disclaimer: This post is for educational purposes only and does not constitute medical advice. The information provided is based on the clinical experience and expertise of Dr. Alex Jimenez and his collaborative team. Always consult with a qualified healthcare provider for diagnosis and treatment of any medical condition. This description is a general overview of the procedure and may vary based on individual patient needs and clinical judgment.