Skin Health and Inflammation in Injury Care

Abstract

In this educational post, I will explore the intricate connection between systemic inflammation, skin health, and integrative medicine. We will begin by examining a common minor surgical procedure—the excision of a dysplastic nevus—to illustrate the principles of localized anesthesia. This also demonstrates patient comfort. From there, we will broaden our scope to discuss how these skin manifestations can indicate deeper systemic issues. In particular, they may signal chronic inflammation. We will explore the physiological pathways linking inflammation to conditions like joint pain and metabolic dysfunction. We will also discuss compromised nervous system health. Finally, I will explain how our multidisciplinary team at the Injury Medical Clinic integrates chiropractic care, functional medicine, and conventional medical oversight. This helps us provide a comprehensive, patient-centered approach to diagnostics and treatment. Ultimately, we aim to address the root causes of disease, not just the symptoms.

Our Integrative Approach at Injury Medical Clinic

As a Doctor of Chiropractic with advanced certifications in functional and integrative medicine, I build my practice on a foundation of understanding the body as an interconnected system. At the Injury Medical Clinic PA, we champion a multidisciplinary model. I am honored to work alongside Dr. Maria Guadalupe Cardenas, MD, a highly experienced, board-certified internist and our Medical Director. She is also our Collaborative Physician. Dr. Cardenas brings over 40 years of invaluable clinical experience. As a result, she provides essential medical oversight that complements our holistic services.

This collaborative setup allows us to offer a truly integrative experience. Our team combines the strengths of:

• Medical Oversight (Dr. Cardenas): Providing traditional medical diagnostics, prescriptions, and management, ensuring all treatments are safe and clinically appropriate.
• Chiropractic and Neuromusculoskeletal Care (Dr. Jimenez): Focusing on spinal alignment, nervous system function, and biomechanics to restore structural integrity and reduce physical stress.
• Functional Medicine: Investigating the root causes of chronic conditions by examining lifestyle, genetics, and environmental factors.
• Rehabilitation and Personal Injury Care: Developing customized programs to restore function, manage pain, and facilitate recovery after an injury.

This comprehensive model ensures that whether a patient presents with a skin lesion, chronic back pain, or metabolic syndrome, they receive care that addresses both the immediate symptoms and the underlying systemic imbalances.

A Practical Look: Minor Skin Surgery and Anesthesia

Let’s begin with a common clinical scenario that provides a window into our patient-centered approach. I performed a re-excision of a lesion on a 62-year-old patient. A shave biopsy performed about a month prior had identified the lesion as a dysplastic nevus with moderate atypia. These are atypical moles that have a higher potential to develop into melanoma. Current guidelines recommend complete removal with clear, narrow margins to prevent recurrence or progression (Oakley et al., 2023).

The Field Block: Creating a “Pain-Free Zone”

My primary goal, besides successful lesion removal, is to ensure the patient’s comfort. To achieve this, I utilize a technique called a field block. Instead of just numbing the immediate area, a field block creates an “anesthetic fence” around the entire surgical site. This method is highly effective for ensuring a completely pain-free experience during the procedure.

Here’s a step-by-step breakdown of the process:

1. Preparation and Planning: The skin was first prepped with alcohol. I then used a sterile surgical marker and a template to plan the elliptical excision precisely. The original lesion was 5 by 6 millimeters, and to ensure adequate margins, my plan included an additional 2 millimeters around the original scar, for a total clearance of about 5 millimeters from the initial lesion. This precision is critical in dermatological surgery to minimize the risk of leaving atypical cells behind.
2. Initial Numbing with Cryoanesthesia: To eliminate the initial needle prick, which is often the most anxiety-inducing part for patients, I use a free spray (a cryoanesthetic agent). I sprayed it directly over the planned injection point. The intense cold provides immediate, temporary numbness. When I asked the patient if he felt the needle, he said, “No,” which is precisely the outcome this technique is designed for.
3. Subcutaneous Injection: I began by injecting 1% lidocaine with epinephrine into the subcutaneous tissue beneath the lesion. Lidocaine is a local anesthetic that blocks sodium channels in nerve fibers, preventing them from transmitting pain signals to the brain. Adding epinephrine is crucial; it’s a vasoconstrictor that narrows blood vessels in the area. This serves two purposes:
   • It reduces bleeding during the excision.
   • It slows lidocaine absorption into the bloodstream, prolonging its numbing effect and keeping the anesthesia localized (Becker & Reed, 2012).
4. Creating the Anesthetic Fence (Intradermal Injection): After anesthetizing the deeper tissue, I proceeded with intradermal injections to form the field block. Using a long, flexible needle, I inserted it at one corner of my marked ellipse.
   • I carefully advanced the needle just beneath the skin’s surface (in the dermis), where the nerve endings are most concentrated. The needle tip was visible through the skin, allowing for precise placement.
   • I injected the anesthetic as I slowly withdrew the needle, creating a line of numbed tissue. You could see the skin rise slightly, a sign of successful intradermal delivery.
   • Without removing the needle entirely, I pivoted from the same entry point and repeated the process on the other side of the ellipse. This minimizes the number of skin punctures.
   • I then repeated the entire process from the opposite corner, ensuring the entire surgical field was encircled by the anesthetic.

Throughout this process, I maintained communication with the patient, who confirmed he felt no pain whatsoever. This meticulous, multi-step approach transforms what could be an uncomfortable procedure into a stress-free experience, which is a cornerstone of our practice philosophy.

The Bigger Picture: Skin Lesions as Markers of Systemic Inflammation

While the excision of a dysplastic nevus is a localized treatment, it’s crucial to ask a broader question: Why did this atypical lesion develop in the first place? In functional medicine, we view the skin as a mirror reflecting the body’s internal health. Skin conditions, from acne and eczema to more serious issues like dysplastic nevi, can often reflect underlying systemic inflammation.

Chronic inflammation is a prolonged, dysregulated immune response that can damage tissues and organs over time. It is a common denominator in a vast array of chronic diseases. This includes cardiovascular disease, type 2 diabetes, autoimmune disorders, and even certain cancers (Furman et al., 2019).

How Inflammation Affects the Skin

Inflammation impacts skin health through several key mechanisms:

• Oxidative Stress: Chronic inflammation generates an excess of free radicals—unstable molecules that damage cellular structures, including DNA. This DNA damage can lead to mutations in skin cells (melanocytes), potentially contributing to atypical nevi and increasing melanoma risk.
• Immune Dysregulation: A healthy immune system identifies and eliminates abnormal cells. However, chronic inflammation can impair this surveillance function, allowing atypical cells to proliferate.
• Hormonal Imbalances: Inflammation can disrupt the delicate balance of hormones like cortisol and insulin. Insulin resistance, a hallmark of pre-diabetes and metabolic syndrome, is a pro-inflammatory state linked to various skin issues, including skin tags and acanthosis nigricans.

When I see a patient with a skin issue like a dysplastic nevus, my clinical mind immediately considers these connections. While Dr. Cardenas and I address the immediate dermatological need, our functional medicine approach compels us to investigate for underlying inflammatory triggers. This involves comprehensive lab testing to assess inflammatory markers (like C-reactive protein), nutrient deficiencies, hormonal imbalances, and gut health.

The Chiropractic Link: Spinal Health and Nervous System Regulation

So, where does chiropractic care fit into this picture of inflammation and systemic health? The connection lies in the intricate relationship between the spine, the nervous system, and the body’s ability to regulate itself—a concept known as homeostasis.

The nervous system, particularly the autonomic nervous system (ANS), is the body’s master control system. The ANS has two main branches:

• The Sympathetic Nervous System: The “fight-or-flight” response. It mobilizes the body for action by increasing heart rate and blood pressure and releasing inflammatory molecules.
• The Parasympathetic Nervous System: The “rest-and-digest” response. It promotes calm, digestion, repair, and anti-inflammatory processes.

In a healthy individual, these two systems exist in a dynamic balance. However, chronic stress—be it physical, chemical, or emotional—can lead to sympathetic dominance, where the “fight-or-flight” response is persistently activated. This state is inherently pro-inflammatory.

Spinal Misalignments and Neurological Interference

Chiropractic care focuses on identifying and correcting vertebral subluxations—misalignments or dysfunctional segments in the spine that can interfere with normal nervous system function. Here’s how this connects to inflammation:

• Structural Stress: A misaligned spine places abnormal mechanical stress on joints, muscles, and ligaments. This physical stress is a powerful trigger for a localized, and eventually systemic, inflammatory response.
• Nerve Irritation: Subluxations can irritate or compress the delicate spinal nerves that exit the spinal column. Since these nerves are the communication pathways between the brain and every cell in the body, this interference can disrupt the signals that regulate organ function and the immune system.
• ANS Imbalance: Research suggests that chiropractic adjustments can directly influence the autonomic nervous system. By restoring proper spinal mechanics and reducing neurological irritation, adjustments can help shift the body away from sympathetic dominance and toward a more balanced, parasympathetic (“rest and repair”) state (Innes et al., 2024). This modulation can help lower systemic inflammation.

In my clinical experience, patients undergoing regular chiropractic care often report improvements in conditions seemingly unrelated to their back pain. For example, they may experience better digestion, improved sleep, and fewer allergy symptoms. This reflects the powerful, system-wide effects of optimizing nervous system function. For the 62-year-old gentleman, an integrative plan would not only involve monitoring his skin but also assessing his spinal health. This ensures his nervous system functions optimally to manage inflammation and support his body’s natural healing and surveillance mechanisms.

Creating a Holistic Treatment Plan

Our integrative approach combines these principles into a cohesive, personalized treatment strategy.

1. Comprehensive Assessment: This begins with a detailed history and physical exam, followed by both conventional and functional lab testing. We might assess inflammatory markers, nutrient levels, hormone profiles, and gut microbiome health. A chiropractic evaluation would assess spinal alignment and neurological function.
2. Addressing the Root Cause: Based on the findings, we develop a multi-pronged plan.
   • Medical Management (Dr. Cardenas): If needed, Dr. Cardenas provides medical interventions, such as prescriptions to manage high blood pressure or diabetes, which are often linked to inflammation.
   • Chiropractic Adjustments (Dr. Jimenez): I would use specific, targeted adjustments to correct spinal subluxations, reduce neurological stress, and help rebalance the autonomic nervous system.
   • Functional Nutrition: We provide dietary guidance to reduce inflammation. This often includes an anti-inflammatory diet rich in omega-3 fatty acids, antioxidants, and phytonutrients, while eliminating pro-inflammatory foods like processed sugars and refined carbohydrates.
   • Lifestyle Modifications: We coach patients on stress-management techniques (like mindfulness and breathing exercises), improving sleep hygiene, and incorporating appropriate physical activity—all powerful tools for reducing sympathetic dominance and inflammation.
   • Targeted Supplementation: We may recommend specific supplements, such as curcumin, omega-3s, or vitamin D, to help modulate the inflammatory response and correct nutrient deficiencies identified in lab testing.

By weaving together these different modalities, we move beyond simply managing symptoms. We empower the body’s innate ability to heal and regulate itself, addressing the root causes of dysfunction to foster true, long-term health and well-being. This is the future of healthcare—collaborative, patient-centered, and deeply rooted in the science of how our bodies work.

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References

• Becker, D. E., & Reed, K. L. (2012). Local anesthetics: review of pharmacological considerations. Anesthesia Progress, 59(2), 90–102. https://doi.org/10.2344/0003-3006-59.2.90
• Furman, D., Campisi, J., Verdin, E., Carrera-Bastos, P., Targ, S., Franceschi, C., Ferrucci, L., Gilroy, D. W., Fasano, A., Miller, G. W., Miller, A. H., Mantovani, A., Weyand, C. M., Barzilai, N., Goronzy, J. J., Rando, T. A., Effros, R. B., slavich, G. M., & Fantuzzi, G. (2019). Chronic inflammation in the etiology of disease across the life span. Nature Medicine, 25(12), 1822–1832. https://doi.org/10.1038/s41591-019-0675-0
• Innes, S. I., Leboeuf-Yde, C., & Walker, B. F. (2024). The chiropractic profession’s focus on the vertebral subluxation: A literature review of the disconnect between theory and clinical practice. Chiropractic & Manual Therapies, 32(1), 16. https://doi.org/10.1186/s12998-024-00539-7
• Oakley, A., Stanway, A., & Bell, B. (2023). Dysplastic naevus. DermNet. Retrieved from https://dermnetnz.org/topics/dysplastic-naevus