Functional Medicine Benefits for Skin Health & Inflammation

Learn how functional medicine approaches can improve skin health by reducing inflammation and enhancing overall wellness.

Abstract

As a Doctor of Chiropractic with advanced certifications as a Nurse Practitioner and in Functional Medicine, I provide comprehensive, evidence-based care. In this educational post, I will guide you through diagnosing and managing a common clinical presentation: an inflamed skin lesion. We will explore the case of a middle-aged gentleman who presented with a painful, inflamed lesion on his hip, which we clinically identified as a probable seborrheic keratosis. This post details the step-by-step procedure for a shave skin biopsy, a crucial diagnostic tool for confirming the nature of such lesions. I will explain the physiological reasoning behind each step, from the local anesthesia technique using lidocaine with epinephrine to the shave biopsy itself and subsequent hemostasis with aluminum chloride.

Furthermore, I will discuss the importance of an integrative care model in managing patient health comprehensively. At our practice, Injury Medical Clinic, I work alongside Dr. Maria Guadalupe Cardenas, MD, our esteemed Medical Director and an internist with over 40 years of experience. This collaborative framework lets us merge the principles of chiropractic care, functional medicine, internal medicine, and rehabilitation to address not just the symptom—like a skin lesion—but the underlying systemic factors that may affect a patient’s overall health and well-being. We will delve into how this multidisciplinary approach ensures patient safety, provides a holistic perspective, and optimizes outcomes by treating the whole person.

Our Integrative Care Philosophy at Injury Medical Clinic

At Injury Medical Clinic, our mission is to provide patient-centered care that transcends traditional disciplinary boundaries. We have cultivated a unique clinical environment where multiple healthcare philosophies converge to offer a truly holistic treatment experience. This model is built on the collaborative relationship between me, Dr. Alex Jimenez (DC, APRN, FNP-BC, CFMP, IFMCP, ATN, CCST), and our Medical Director and Collaborative Physician, Dr. Maria Guadalupe Cardenas, MD (Board Certified in Internal Medicine).

Dr. Cardenas brings a wealth of knowledge from her more than four decades as an internist (NPI #1164426749, Texas MD License #J2933). Her role is fundamental to our practice. As Medical Director, she provides essential medical oversight, ensuring all our protocols and treatments meet the highest standards of medical safety and efficacy. This type of multidisciplinary setup is increasingly recognized as a best-practice model, particularly in integrative and injury care clinics. It allows a Doctor of Chiropractic (DC) like myself, with advanced training as a Family Nurse Practitioner (FNP-BC) and in Functional Medicine, to work in concert with an experienced Medical Doctor (MD).

This synergy allows our team to offer a broad spectrum of services under one roof:

• Chiropractic Care: I focus on the body’s biomechanics, addressing musculoskeletal issues, nerve function, and spinal health. This is the foundation of our physical medicine approach.
• Medical Oversight (Internal Medicine): Cardenas provides comprehensive medical evaluations, manages systemic health conditions, and offers crucial diagnostic insights to ensure we don’t overlook underlying medical issues.
• Functional Medicine: We delve deep into the root causes of dysfunction, using advanced diagnostic testing to understand a patient’s unique biochemistry, genetics, and lifestyle factors.
• Personal Injury and Rehabilitation: Our team is equipped to manage the complex needs of patients recovering from injuries, integrating physical therapies, rehabilitation exercises, and pain management strategies.

When a patient presents with an issue like a skin lesion, this integrated model becomes invaluable. While I may perform the initial assessment and procedure within my scope as an FNP, Dr. Cardenas’s oversight ensures a comprehensive differential diagnosis and follow-up plan. This collaboration ensures we treat not just a localized symptom but the patient’s entire physiological landscape, from musculoskeletal alignment to metabolic health.

A Clinical Scenario: The Inflamed Seborrheic Keratosis

A few weeks ago, a middle-aged gentleman came to our clinic with a specific concern. He pointed to the lateral aspect of his right hip, where a skin lesion had become increasingly noticeable over the past four weeks. It wasn’t just its appearance that troubled him; the lesion was now causing inflammation and pain.

On clinical examination, the lesion showed the classic features of an inflamed seborrheic keratosis. Seborrheic keratoses are very common, non-cancerous (benign) skin growths that people tend to develop as they age. They often appear as brown, black, or light tan growths on the face, chest, shoulders, or back. They have a waxy, scaly, and slightly elevated appearance, sometimes described as looking “pasted on” the skin.

While harmless, they can become a problem when irritated. This can happen from friction, like clothing rubbing against them, or for other unknown reasons. When irritated, they can become inflamed, red, itchy, and painful—exactly what our patient was experiencing. Although my clinical judgment strongly pointed toward a benign diagnosis, a core principle of evidence-based medicine is never to assume. The gold standard for a definitive diagnosis is a histopathological examination of the tissue. Therefore, the clear course of action was to perform a shave skin biopsy. This procedure would not only provide a tissue sample for the pathologist but would also serve a therapeutic purpose by removing the irritated lesion.

The Shave Biopsy Procedure: A Step-by-Step Explanation

The goal of a shave biopsy is to remove the outermost layers of the skin (the epidermis and a portion of the dermis) that contain the lesion. It is a minimally invasive, efficient, and highly effective technique for both diagnosing and treating raised skin lesions. I’ll walk you through the exact steps we took for this patient, explaining the “why” behind each action.

1. Preparation and Anesthesia: Ensuring Patient Comfort and Procedural Precision

The first and most critical step in any minor surgical procedure is ensuring the patient is comfortable and the area is properly prepared.

• Cleansing the Area: I began by thoroughly cleaning the skin over and around the lesion with an alcohol pad. This standard aseptic technique reduces the microbial load on the skin’s surface, minimizing the risk of post-procedural infection.
• Topical Anesthetic Spray: To mitigate the initial pain of the needle stick, I used a topical vasoconstrictor spray called Pain Ease® Mist. This spray rapidly cools the skin, creating a temporary numbing effect. The mechanism is based on the Gate Control Theory of Pain. The intense cold sensation travels along large-diameter A-beta nerve fibers, which are faster than the smaller A-delta and C fibers that transmit pain signals. The “gate” for pain signals in the spinal cord is effectively “closed” by the overwhelming cold sensation, making the subsequent needle insertion much more tolerable for the patient.
• Local Anesthetic Injection: The cornerstone of local anesthesia for this procedure is injecting a local anesthetic agent. I used 1% lidocaine with epinephrine, injecting approximately 1 mL into the subcutaneous tissue. Let’s break down why this specific combination is so effective:

• • Lidocaine: This is an amide-type local anesthetic. Its primary function is to block nerve conduction, thereby preventing pain signals from reaching the brain. It achieves this by reversibly binding to and inactivating voltage-gated sodium channels within the nerve cell membrane. When these channels are blocked, the influx of sodium ions required to generate and propagate an action potential is prevented. No action potential means no pain signal transmission.
  • Epinephrine: This is a vasoconstrictor. Its inclusion serves two vital purposes. First, by constricting local blood vessels, it reduces blood flow at the injection site. This slows the rate at which lidocaine is absorbed into the systemic circulation, prolonging the anesthetic effect and keeping the area numb longer. Second, reduced blood flow provides hemostasis, minimizing bleeding during the biopsy procedure. This creates a clearer surgical field for me and reduces the total amount of bleeding the patient experiences.

I used a very fine 30-gauge, half-inch needle to minimize tissue trauma and discomfort. I quickly inserted it into the subcutaneous tissue just beneath the lesion and injected the anesthetic. The patient confirmed he felt no pain.

2. Creating an Intradermal Wheal: Elevating the Lesion for an Optimal Biopsy

After the initial subcutaneous injection, I let the anesthetic sit for a moment to take effect. Then, without fully removing the needle, I redirected it. This technique avoids a second painful needle puncture. I carefully advanced the needle horizontally, positioning it in the intradermal space directly underneath the lesion.

As I slowly injected the remaining lidocaine solution into this superficial layer, a visible, pale, and firm raised area of skin began to form. This is known as an intradermal wheal. The formation of this wheal is a crucial part of the technique for several reasons:

1. Anesthetizes the Superficial Nerves: The dermis is rich with sensory nerve endings. Injecting the anesthetic directly into this layer ensures that the most superficial, and therefore most sensitive, part of the skin is completely numb. I asked the patient if he felt a stinging sensation, which is common as the fluid expands the dermal tissue, but he reported none.
2. Elevates the Lesion: This is the most brilliant mechanical advantage of the intradermal wheal. By injecting fluid directly beneath the lesion, we use hydraulic pressure to lift the entire lesion up and away from the deeper subcutaneous tissues. It essentially “presents” the lesion to me on a platter.
3. Creates a Firm Plane for Shaving: The wheal makes the skin taut and firm. This provides a stable, flat surface, allowing for a smooth, controlled, and even shave. It prevents the blade from skipping or digging too deep, ensuring that I can remove the lesion at the desired depth with a single, fluid motion.

You could see the wheal developing, and with it, the seborrheic keratosis was elevated perfectly, ready for removal.

3. The Shave Biopsy: Precise and Efficient Removal

With the lesion anesthetized and elevated, it was time to shave. Using a sterile, flexible razor blade (or a specialized tool like a DermaBlade), I began the incision about two millimeters lateral to the visible edge of the lesion. This margin ensures that the entire lesion is captured within the specimen, which is important for the pathologist to make an accurate diagnosis.

I held the blade parallel to the skin surface and used a gentle, horizontal, sawing motion to pass it through the base of the lesion, staying within the plane of the intradermal wheal. The goal is to be deep enough to remove the entire lesion but shallow enough to avoid significant scarring. The anesthetic wheal acts as a perfect guide for this depth.

I continued the motion through to the other side of the lesion. In one clean pass, I removed the entire lesion, leaving a smooth, shallow dermal wound. I immediately placed the specimen in a container with formalin, a preservative that fixes the tissue for transport to the pathology lab. On the patient’s skin, I saw no residual lesional tissue.

4. Hemostasis: Achieving a Bloodless Field

Even with epinephrine’s vasoconstrictive effects, a superficial dermal wound will ooze blood. Prompt, effective hemostasis (cessation of bleeding) is essential for patient comfort, infection prevention, and proper wound healing.

For shave biopsies, the hemostatic agent of choice is often chemical. In this case, I used aluminum chloride. I saturated a sterile gauze pad with a 20% aluminum chloride solution (a common concentration for this purpose). I applied it directly to the wound bed with firm pressure for about a minute.

Aluminum chloride works as a potent chemical styptic agent. Its mechanism of action is twofold:

• It causes superficial tissue necrosis by denaturing proteins, which effectively seals the cut ends of the small capillaries in the dermis.
• It interacts with blood proteins, particularly fibrinogen, to form a mechanical plug that occludes the bleeding vessels.

The effect was immediate and impressive. As soon as I removed the gauze, the bleeding stopped completely. The wound bed was clean and dry, ready for dressing.

5. Final Steps: Dressing and Patient Instructions

The final step was to apply a sterile dressing. I typically use a small amount of antibiotic ointment (like bacitracin or mupirocin) to provide a moist healing environment and an extra layer of infection protection, followed by a simple adhesive bandage.

I then provided the patient with clear aftercare instructions:

• Keep the area clean and dry for the first 24 hours.
• After 24 hours, he could gently clean the area daily with soap and water.
• Apply a thin layer of antibiotic ointment and a new bandage daily until the wound has fully epithelialized (formed a new layer of skin), which usually takes 7-10 days.
• We scheduled a follow-up appointment in two weeks to discuss the pathology report and check on the wound’s healing.

The Healing Diet: Combat Inflammation, Embrace Wellness- Video

The Role of Integrative Chiropractic Care in Overall Wellness

Now, you might be wondering: what does a skin biopsy have to do with chiropractic care? This is where the beauty of an integrative and functional medicine approach comes into full view. At Injury Medical Clinic, my role as a Doctor of Chiropractic goes beyond spinal adjustments. My advanced training allows me to see the body as an interconnected system, where one issue can reflect a deeper, systemic imbalance.

While a seborrheic keratosis is a benign skin condition, skin health often mirrors internal health. Conditions like inflammation, oxidative stress, and hormonal imbalances can manifest on the skin. Here’s how our integrative model connects these dots:

Chiropractic Care and Neuro-Endocrine-Immune Function

The nervous system is the body’s master controller, regulating everything from muscle contraction to immune responses and hormone secretion. Chiropractic care, at its core, focuses on optimizing nervous system function by correcting vertebral subluxations—spinal misalignments that can interfere with nerve signaling.

• Systemic Inflammation: Chronic pain and inflammation, whether from a skin lesion or a musculoskeletal issue, activate the body’s stress response system, primarily the Hypothalamic-Pituitary-Adrenal (HPA) axis. Persistent activation can dysregulate cortisol, the body’s main stress hormone. This can, in turn, promote systemic inflammation, which can exacerbate skin conditions and impair wound healing. Some research shows chiropractic adjustments can modulate the autonomic nervous system and influence the HPA axis, potentially helping downregulate systemic inflammation. By addressing musculoskeletal stress through chiropractic care, we can help calm the nervous system and, in turn, reduce the body’s overall inflammatory burden.
• Immune System Modulation: The nervous system and the immune system are intricately linked in a field of study called psychoneuroimmunology. Nerve fibers innervate lymphoid organs like the spleen and lymph nodes. By improving neuromuscular function, chiropractic care may help support a balanced immune response, which is crucial for fighting potential skin infections and supporting proper wound healing.

Functional Medicine: Looking Deeper

As a Certified Functional Medicine Practitioner (CFMP, IFMCP), my goal is to investigate the “why” behind a patient’s symptoms. In the context of skin health, this means looking at:

• Gut Health: The gut is a major regulator of inflammation and immune function. A condition known as “leaky gut” or increased intestinal permeability can allow inflammatory molecules and undigested food particles to enter the bloodstream, triggering systemic inflammation that can manifest in the skin (the “gut-skin axis”).
• Nutrient Deficiencies: Proper wound healing is highly dependent on an adequate supply of key nutrients, including Vitamin C (for collagen synthesis), Zinc (for cell proliferation and immune function), Vitamin A (for epithelialization), and protein (the building blocks for new tissue). A functional medicine workup can identify and correct these deficiencies through targeted nutrition and supplementation.
• Oxidative Stress: The process of inflammation generates free radicals, which cause oxidative stress and damage to cells. We can assess a patient’s antioxidant status and recommend a diet rich in colorful fruits and vegetables, along with specific supplements like glutathione or N-acetylcysteine, to help quench this oxidative stress and support cellular repair.

Putting It All Together for the Patient

For the gentleman with the hip lesion, our integrative plan extends beyond the simple biopsy.

1. Immediate Care: The shave biopsy, overseen medically by Dr. Cardenas, addresses the immediate pain and inflammation.
2. Chiropractic Assessment: I would also perform a full spinal and biomechanical assessment. Does he have a pelvic obliquity or sacroiliac joint dysfunction causing gait changes that lead to his clothing rubbing on that specific spot on his hip? Addressing this underlying biomechanical issue could prevent future irritation of other skin lesions.
3. Functional Medicine Investigation: We would discuss his diet, stress levels, and overall health. If he shows other signs of systemic inflammation (e.g., joint pain, fatigue, digestive issues), we might recommend advanced testing to look at inflammatory markers, gut health, or nutrient levels.
4. Rehabilitation and Lifestyle: Our plan would incorporate recommendations for an anti-inflammatory diet, stress management techniques, and appropriate physical activity to support his overall health, promote efficient wound healing, and reduce his risk of future inflammatory issues.

This comprehensive approach, guided by the collaborative expertise of Dr. Cardenas and me, ensures that we are not just removing a benign skin growth. We are using this clinical encounter as an opportunity to assess and optimize the patient’s entire well-being, embodying the true spirit of integrative medicine. The pathology report will give us a definitive diagnosis, and our holistic plan will support the patient’s journey toward lasting health.

References

• Berman, B., & Amini, S. (2012). Pharmacotherapy of benign and premalignant cutaneous tumors. Expert Opinion on Pharmacotherapy, 13(12), 1729–1745.
• Farrell, A. M., & Staughton, R. C. (2002). Local anesthesia. Postgraduate Medical Journal, 78(920), 357–361.
• Melzack, R., & Wall, P. D. (1965). Pain mechanisms: A new theory. Science, 150(3699), 971–979.
• Zuber, T. J. (2002). The shave biopsy. American Family Physician, 65(6), 1165–1168.

Clinical Observations and Further Reading

For those interested in exploring the clinical application of these principles in more detail, I invite you to review my professional insights and case studies, which reflect my extensive experience in chiropractic, functional medicine, and advanced nursing practice.

• Clinical insights on sciatica and related neuro-musculoskeletal conditions: Sciatica Clinic
• Professional profile and articles on integrative health: Alex Jimenez on LinkedIn

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