A Functional Medicine Guide for Skin Health & Inflammation

Enhance your skin health by understanding inflammation through the lens of functional medicine and its benefits.

Educational Abstract Summary: Integrative Evaluation and Management of an Inflamed Seborrheic Keratosis With Biopsy, Pain Control, and Multidisciplinary Follow-up

In this educational post, I, Dr. Alex Jimenez, DC, APRN, FNP-BC, CFMP, IFMCP, ATN, CCST, present a clear, first-person walkthrough of a common dermatologic scenario seen in integrated musculoskeletal and injury clinics: an inflamed seborrheic keratosis on the lateral hip requiring a shave biopsy for diagnosis and relief. I explain step-by-step procedures for local anesthesia and tissue sampling, the physiological basis of pain control and hemostasis, and the rationale behind each clinical decision, drawing on modern, evidence-based research. I also describe our collaborative model with our Medical Director and Collaborative Physician, Dr. Maria Guadalupe Cardenas, MD (Board Certified in Internal Medicine; NPI #1164426749; Texas MD License #J2933), a seasoned internist with over 40 years of experience, at Injury Medical Clinic PA (also known as Mission Plaza Injury Medical Clinic) in El Paso, Texas. Together, we integrate chiropractic care, internal medicine oversight, functional medicine, personal injury care, and rehabilitation to ensure comprehensive, safe, and outcome-focused care. This post includes practical procedural insights, safety pearls, clinical observations from my practice, and an evidence-based framework that links dermatologic evaluation to broader integrative health strategies.

Note: This post is intended for educational purposes and to guide patients and professionals through the logic and safety steps of evaluation and care within an integrative clinic model.

My First-Person Narrative: Evaluating and Treating an Inflamed Lateral Hip Lesion

I saw a middle-aged gentleman who came in with a noticeable skin lesion over the lateral aspect of his right hip. Over about four weeks, it had enlarged, become inflamed, and become tender. On exam, the lesion had the classic appearance of an inflamed seborrheic keratosis: a stuck-on, waxy-surfaced plaque with surrounding erythema and irritation. The lateral hip is a high-friction, pressure-prone zone—belt lines, waistbands, and daily movement can rub this area, and even benign lesions can become inflamed and painful with repetitive microtrauma.

Given the symptomatic presentation and the recent growth, I decided to perform a shave biopsy to confirm the diagnosis and relieve the irritated surface. Before any invasive step, I obtained informed consent, clarified the purpose—to confirm that this is indeed a benign seborrheic keratosis and to remove the irritated superficial component—and reviewed risks such as bleeding, infection, scarring, and the very low but real possibility of a more serious diagnosis requiring additional treatment. I also reinforced how we use pathologic tissue assessment to differentiate benign, inflamed lesions from actinic keratoses or nonmelanoma skin cancers, which can sometimes mimic seborrheic keratoses.

Pain Control and Patient Comfort: Step-by-Step Local Anesthesia

• I first cleansed the area thoroughly with alcohol to reduce bacterial load.
• For additional comfort, I applied a brief pain-ease mist (VapoCoolant) to numb the skin surface. These sprays work by evaporative cooling, which temporarily slows cutaneous nerve conduction and reduces pain during needle insertion.
• Using a 30-gauge, half-inch needle, I introduced local anesthetic—1% lidocaine with epinephrine—into the subcutaneous tissue. I injected approximately 1 mL. The epinephrine (adrenaline) component constricts local blood vessels (via alpha-1 adrenergic receptor activation), limiting bleeding during the shave and prolonging the anesthetic effect by slowing systemic absorption.
• After the initial infiltration, I redirected the needle horizontally without withdrawing, moving into the intradermal plane beneath the lesion to raise a wheal—a small, elevated bleb. This lifts the lesion and enhances local anesthesia precisely where the shave will occur. The wheal also helps physically present the lesion to the blade, improving control and minimizing the need for deeper passes.
• I asked the patient for feedback at each step. He reported minimal discomfort, which is what I aim for with meticulous technique and patient-centered pacing.

Physiologically, lidocaine blocks voltage-gated sodium channels in peripheral nerves, halting action-potential propagation and, therefore, pain signal transmission. The intradermal wheal targets the densely innervated superficial dermis, where cutaneous pain fibers are most concentrated, producing precise anesthesia ideal for superficial procedures like shave biopsies.

Performing the Shave Biopsy: Precise Technique for Diagnosis and Relief

• With the intradermal wheal elevating the lesion, I positioned the blade about 2 mm lateral to the lesion’s edge to capture the entire raised component in one controlled pass. This approach helps avoid leaving residual elevated tissue and improves cosmetic and symptomatic outcomes.
• I executed a smooth, shallow pass through the epidermis and superficial dermis, removing the lesion entirely. The aim is to keep the cut superficial to minimize scarring while still obtaining diagnostic tissue. For seborrheic keratoses, which are epidermal proliferations with characteristic horn pseudocysts, a superficial sample is usually sufficient for diagnosis.
• Once the lesion was removed, I controlled minor bleeding with aluminum chloride solution applied via a gauze pad. Aluminum chloride acts as a hemostatic agent by precipitating proteins and causing vasoconstriction at the cut surface, achieving rapid hemostasis without cautery in most superficial shaves.
• I prepared the specimen for pathology in a sterile container, labeled carefully with the anatomic site, and followed chain-of-custody documentation consistent with medical standards.

The patient tolerated the procedure well, with bleeding controlled quickly and no residual lesion left in the field.

Why a Shave Biopsy for Suspected Inflamed Seborrheic Keratosis

Seborrheic keratoses are common benign epidermal neoplasms that can become inflamed. Clinically, they appear as stuck-on, well-circumscribed plaques with variable pigmentation and a waxy, verrucous texture. Inflammation can result from mechanical irritation or immune-mediated reactions. A shave biopsy is the preferred diagnostic and therapeutic method for symptomatic, irritated lesions because:

• It provides a histological specimen to confirm the diagnosis and exclude mimickers such as pigmented basal cell carcinoma, Bowen’s disease (SCC in situ), or melanoma in situ, which can rarely mimic seborrheic keratosis clinically.
• It relieves the symptomatic raised portion, reducing friction and discomfort.
• It heals quickly with minimal scarring, particularly in areas not under excessive tension.

By choosing a shave technique, I balance diagnostic yield, cosmetic outcomes, and patient comfort, aligned with dermatologic procedural standards.

Integrating Chiropractic Care With Medical Oversight in an Injury-Focused Clinic

At Injury Medical Clinic PA (Mission Plaza Injury Medical Clinic) in El Paso, Texas, our model is collaborative and integrative. I serve as a chiropractor and advanced practice clinician, and I work under the medical direction and collaboration of Dr. Maria Guadalupe Cardenas, MD (NPI #1164426749; Texas MD License #J2933), who is Board Certified in Internal Medicine and has more than four decades of clinical experience as an internist.

• Cardenas provides medical oversight and ensures any procedure—like this shave biopsy—aligns with internal medicine standards, including appropriate anesthesia use, hemostasis protocols, specimen handling, and follow-up diagnostics.
• My role includes comprehensive musculoskeletal and integrative assessments, chiropractic adjustments, rehabilitation planning, and procedural care for conditions that intersect with injury and functional medicine domains.

This multidisciplinary approach is common in integrative and injury care clinics. An MD provides the medical direction necessary to supervise procedures, manage medications, interpret pathology results, and guide systemic evaluations. At the same time, the chiropractic clinician integrates biomechanical assessments, soft-tissue and joint interventions, and functional recovery strategies. Together, we offer coordinated care that spans from diagnostics to rehabilitation and prevention.

How We Integrate Functional Medicine Principles Into Skin, Pain, and Recovery Care

Beyond the shave biopsy, we consider systemic contributors to inflammation and pain:

• We assess metabolic factors such as glycemic control, which influences wound healing and infection risk.
• We review medication and supplement histories that may affect bleeding or healing, including antiplatelet agents or herbal products.
• We consider nutritional status—adequate protein, micronutrients like vitamin C and zinc, and omega-3 fatty acids can support dermal repair.
• We screen for mechanical friction sources, such as belts, waistbands, or repetitive side-lying pressure that can inflame lateral hip skin, especially in individuals with hip tenderness or gait changes.

Integrative chiropractic care addresses postural and biomechanical strain that can exacerbate skin friction and soft-tissue irritation. For example, an altered gait from gluteal weakness or hip abductor tenderness can change how clothing interfaces with the lateral hip, increasing rubbing over a lesion. Through targeted rehabilitation and soft-tissue therapies, we reduce these mechanical stressors.

Immediate Aftercare and Follow-Up Plan

• I applied a clean dressing and instructed the patient on wound care: keep the area clean and dry for the first 24 hours, then clean gently with soap and water, and apply a thin layer of petrolatum daily with a fresh bandage until healed.
• I discussed signs of infection—worsening pain, increasing redness, warmth, drainage—and instructed him to contact us immediately if these occur.
• I advised avoiding tight waistbands or belts over the site and minimizing lateral hip pressure (e.g., lying on the opposite side) until re-epithelialization occurs.
• We scheduled a follow-up to review pathology results, typically available within a few business days, and to ensure proper healing.

Under Dr. Cardenas’s medical direction, we align follow-up timing with pathology turnaround and adjust care if unexpected findings emerge.

Why Pain-Ease Mist, Lidocaine with Epinephrine, and Aluminum Chloride

• Pain-ease mist reduces the initial sting of needle entry via rapid skin cooling and transient nerve conduction reduction.
• Lidocaine provides rapid-onset local anesthesia; epinephrine prolongs its effect and reduces bleeding by vasoconstriction, lowering the need for cautery in superficial procedures.
• Aluminum chloride provides quick hemostasis by precipitating proteins and constricting local vessels without thermal damage.

Each element is selected to maximize patient comfort, procedural control, and safety while minimizing complications.

Team-Based Care Model: Medical Direction and Chiropractic Integration

• Maria G. Cardenas, MD: As our Medical Director and Collaborative Physician, she ensures that our procedural standards, consent processes, anesthesia protocols, and pathology workflows meet internal medicine and evidence-based benchmarks. With over 40 years as an internist, she provides systemic insight that enriches our local interventions.
• Alex Jimenez, DC, APRN, FNP-BC: I integrate musculoskeletal expertise, functional medicine insights, and chiropractic care with procedural skills for skin, soft tissue, and pain management in an injury-focused context. My role bridges biomechanics with systemic health considerations, ensuring that a localized issue is addressed within the broader framework of the patient’s overall function and recovery.

The Healing Diet: Combat Inflammation, Embrace Wellness- Video

Why This Matters in an Injury-Focused Clinic

Injury and integrative clinics often encounter cutaneous lesions as incidental findings or secondary issues that become symptomatic due to friction, bracing, tape exposure, or altered biomechanics. Recognizing clinically benign lesions and knowing when to biopsy safeguards the patient, prevents complications, and improves comfort. Coordinating this with functional and rehabilitation strategies helps prevent recurrence and address the root causes of irritation.

Key Takeaways

• An inflamed seborrheic keratosis on the lateral hip can be effectively managed with a shave biopsy that provides diagnostic confirmation and symptomatic relief.
• Pain control using vapocoolant spray and lidocaine with epinephrine, combined with intradermal wheal formation, optimizes comfort and procedural ease.
• Aluminum chloride is a simple, effective hemostatic agent for superficial procedures.
• Integrative clinics benefit from medical direction by an internal medicine physician to ensure evidence-based procedural care while leveraging chiropractic and functional approaches for comprehensive outcomes.
• Addressing biomechanics and lifestyle factors reduces friction and supports healing, linking dermatologic care with broader musculoskeletal and functional medicine strategies.

References

• Zager, J. S., Hochwald, S. N., Marzban, S. S., Francois, R., Law, K. M., Davis, A. H., Messina, J. L., Vincek, V., Mitchell, C., Church, A., Copeland, E. M., Sondak, V. K., & Grobmyer, S. R. (2011). Shave biopsy is a safe and accurate method for the initial evaluation of melanoma. Journal of the American College of Surgeons, 212(4), 454–462. https://doi.org/10.1016/j.jamcollsurg.2010.12.021
• Functional medicine considerations in wound healing and inflammation
• Clinical observations and integrative approaches by Dr. Alexander Jimenez
• Professional profile of Dr. Alex Jimenez

Note: In our practice, all references and protocols align with current, peer-reviewed standards and are tailored to patient-specific needs under medical oversight.

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