Functional Medicine Strategies for Inflammation & Skin Health

Discover effective strategies for skin health, from inflammation to vitality, through the lens of functional medicine.

Educational Abstract: Integrative Evaluation and Shave Biopsy of an Inflamed Seborrheic Keratosis with Multidisciplinary Care Pathways

In this educational post, I guide you through a clear, first-person narrative of how our integrative team evaluates and manages a middle-aged patient presenting with an acutely inflamed skin lesion over the lateral right hip. I describe our clinical reasoning, step-by-step sterile technique for a shave biopsy under local anesthesia, and how we integrate chiropractic care, functional medicine, and medical oversight into the diagnostic and therapeutic pathway. I present the latest evidence on inflamed seborrheic keratoses, including differential diagnosis, procedural pearls, wound care, and relapse-prevention strategies. I also explain how we coordinate with Dr. Maria Guadalupe Cardenas, MD (Board Certified in Internal Medicine; NPI #1164426749; Texas MD License #J2933), who serves as Medical Director and Collaborative Physician of our Injury Medical Clinic PA (Mission Plaza Injury Medical Clinic) in El Paso, Texas, and how our multidisciplinary framework ensures optimal patient safety and outcomes. This post incorporates modern, evidence-based methods; explores the physiology of pain, inflammation, and dermal healing; and explains why specific clinical decisions are made. Finally, I share insights from my clinical observations and research notes on my platforms, including Chiropracticscientist.com and my professional LinkedIn profile, showing how integrative chiropractic care fits into comprehensive injury and dermatologic care plans.

• Author: Dr. Alexander (Alex) Jimenez, DC, APRN, FNP-BC, CFMP, IFMCP, ATN, CCST
• Practice: Injury Medical Clinic PA (Mission Plaza Injury Medical Clinic), El Paso, Texas
• Medical Director and Collaborative Physician: Dr. Maria Guadalupe Cardenas, MD (Internal Medicine)

Introduction to the Case: A Patient with a Painful Lateral Hip Lesion

I met a middle-aged gentleman who came to our clinic with a noticeable lesion on the lateral aspect of his right hip. Over the past four weeks, the lesion had enlarged and become tender, inflamed, and irritated by clothing. The surface was waxy and verrucous, with a stuck-on appearance, and there were signs of excoriation from rubbing. Clinically, it resembled an inflamed seborrheic keratosis—a benign epidermal tumor—but because of its evolution and the patient’s discomfort, we planned a diagnostic and therapeutic shave biopsy.

From the outset, our team’s approach was integrative:

• I managed procedural care, anesthesia, and shave technique, ensuring a gentle, efficient tissue collection for histopathology.
• Maria Guadalupe Cardenas, MD, provided medical oversight—reviewing systemic factors (e.g., medications, coagulopathies, immunosuppression) and supervising the medical protocols to ensure patient safety.
• Our rehabilitation and functional medicine staff evaluated modifiable contributors to recurrent friction, inflammation, and delayed healing—factors often overlooked in dermatologic procedures but critical in active patients or those with comorbidities.

Our goal was to achieve three outcomes: relieve pain, obtain a definitive diagnosis, and reduce recurrence risk by addressing mechanical, metabolic, and lifestyle contributors—all within an integrative chiropractic and medical care framework.

Why an Integrative Medical-Chiropractic Team Evaluates Skin Lesions

While chiropractic care is most commonly associated with neuromusculoskeletal systems, our clinic is multidisciplinary by design. As head of the practice, I am both a chiropractor and an advanced practice registered nurse, board-certified as a family nurse practitioner, with functional medicine credentials. In our care model:

• Cardenas provides medical direction and collaborates on cases requiring internal medicine expertise—including dermatologic conditions that may have systemic drivers.
• I coordinate procedural interventions, musculoskeletal evaluations, ergonomic analyses, and integrative care pathways.
• Our rehab team ensures post-procedural movement strategies reduce friction and shear at the wound site.
• Our functional medicine approach identifies nutritional, metabolic, or inflammatory roadblocks to wound healing.

This coordination ensures that a seemingly simple lesion removal is conducted with clinical rigor, safety, and whole-person outcomes in mind—particularly important in injured or metabolically complex patients.

Understanding Inflamed Seborrheic Keratosis: Pathophysiology and Clinical Clues

Inflamed seborrheic keratosis (ISK) is a common benign lesion characterized by proliferation of basaloid keratinocytes in the epidermis with hyperkeratosis, acanthosis, and pseudohorn cysts. When inflamed, the lesion can become erythematous, pruritic, and painful due to local immune activation and frictional trauma.

Key features I evaluated:

• The “stuck-on” waxy surface with well-demarcated borders and variable pigmentation.
• Surface texture: verrucous or crumbly with keratin debris.
• Evolution: recent irritation and enlargement, with secondary inflammation.
• Location: lateral hip—a region prone to friction from belts, waistbands, or athletic wear.

Physiologically, the pain and inflammation arise from:

• Local release of cytokines (e.g., IL-1B, TNF-a) in response to mechanical irritation.
• Activation of cutaneous nociceptors and mast cells.
• Microtrauma from repetitive contact and pressure, especially over bony prominences like the greater trochanter, which increases shear stress on the lesion.

Differential diagnosis:

• Irritated seborrheic keratosis
• Pigmented actinic keratosis
• Bowen’s disease (SCC in situ)
• Squamous cell carcinoma
• Basal cell carcinoma (superficial, pigmented)
• Melanocytic lesions (e.g., melanoma mimics)
• Verruca (HPV-related)
• Dermatofibroma

Given the lesion’s characteristics and tenderness, a shave biopsy provided both symptomatic relief and a diagnostic specimen. Evidence supports shave removal for typical SKs when malignancy is not strongly suspected, with histology to confirm benignity, particularly in inflamed or atypically evolving lesions.

Safety First: Pre-Procedure Evaluation and Medical Oversight

Before we proceeded, our integrative team confirmed:

• No anticoagulant therapy or bleeding diathesis. If the patient were on anticoagulants, Dr. Cardenas would assess risk-benefit and coordinate peri-procedural management.
• No history of anesthetic allergy, epinephrine sensitivity, or sulfite allergy.
• No signs of systemic infection or immunosuppression that would alter wound care.
• Tetanus status and skin infection precautions if indicated.

Medical oversight matters:

• Cardenas reviewed the patient’s medical history, including any metabolic conditions (e.g., diabetes), vascular disease, or autoimmune disorders that could impair healing.
• Our nursing protocols ensured sterile technique, appropriate consent, and post-procedure instructions tailored to patient comorbidities.

Procedural Narrative: My Step-by-Step Shave Biopsy Technique

I narrate the procedure to help patients and clinicians visualize each step and understand the rationale behind our choices.

• Preparation:

• • I cleansed the lesion and surrounding skin with 70 percent isopropyl alcohol, maintaining aseptic technique.
  • To minimize needle pain, I applied a vapocoolant spray (a cold-induced anesthetic effect) briefly over the area.

• Local anesthesia:

• • Using a 30-gauge, half-inch needle, I inserted it into the subcutaneous layer and infiltrated approximately 1 mL of 1 percent lidocaine with epinephrine.
  • Rationale: Lidocaine blocks voltage-gated sodium channels in nerve fibers, preventing action potential propagation, while epinephrine causes local vasoconstriction via alpha-1 adrenergic receptors, reducing bleeding and prolonging anesthetic effect.
  • I allowed the anesthetic to take effect and then redirected the same needle in a shallow, intradermal plane without fully withdrawing it, creating a wheal beneath the lesion.
  • This intradermal wheal lifts the lesion, reduces resistance, and positions it optimally for a smooth, superficial shave—minimizing residual tissue.

• Shave biopsy:

• • With a sterile, sharp blade, I began the shave approximately 2 mm lateral to the lesion edge, maintaining a gentle, even plane to capture the lesion in its entirety without cutting too deeply into the dermis.
  • A well-controlled shave reduces scarring risk and preserves cosmetic outcome, especially on areas subject to friction.

• Hemostasis:

• • After removing the lesion, I applied aluminum chloride on gauze to achieve hemostasis. Aluminum chloride causes protein precipitation and vasoconstriction at the wound surface, effectively stopping capillary bleeding.

• Specimen handling:

• • I placed the tissue in formalin, labeled it, and prepared it for histopathologic analysis, with clinical notes specifying the lesion’s inflamed character and site.

• Post-procedure:

• • I ensured the wound had no ongoing bleeding, applied a sterile dressing, and provided clear home-care instructions, including signs of infection and when to seek follow-up.

This approach is efficient, well-tolerated, and aligns with evidence-based procedural dermatology.

The Physiology of Pain Control and Patient Comfort

My priority was to make the experience as painless as possible:

• Vapocoolant spray decreases nociceptor firing by rapid cooling, temporarily altering C-fiber and A-delta fiber conduction.
• Fine needles reduce tissue displacement and nociceptor activation.
• Slow infiltration reduces pressure pain; buffering lidocaine with sodium bicarbonate can further reduce sting, though in this case the patient reported minimal discomfort.
• Epinephrine prolongs anesthesia via vasoconstriction, keeping lidocaine localized and extending its duration.
• Intradermal wheal formation elevates the lesion, reducing the pressure needed and lowering mechanical nociception during the shave.

We continuously communicated with the patient to monitor comfort. Pain scores stayed near zero throughout, reflecting the cumulative benefit of these strategies.

Integrating Chiropractic Care: Biomechanics, Friction, and Tissue Stress

Why does chiropractic care matter for a hip lesion?

• The lateral hip overlies the greater trochanter, part of a kinetic chain involving the pelvis, lumbar spine, and lower limb.
• Gait abnormalities, pelvic tilt, gluteal weakness, or tight iliotibial band mechanics can increase shear forces at the lateral hip.
• Clothing and gear contact points shift based on posture and alignment. Subtle postural deviations can concentrate friction on specific skin areas.

My integrative chiropractic assessment included:

• Posture analysis: pelvic obliquity, lumbar lordosis, and iliac crest height differences.
• Gait evaluation: stance time asymmetry, hip abductor function, and Trendelenburg signs.
• Palpation and functional testing: IT band tension, gluteus medius strength, and myofascial trigger points along the TFL-ITB complex.

Interventions:

• Gentle manual therapy to balance pelvic mechanics and reduce lateral hip tension.
• Targeted gluteal strengthening to improve load distribution.
• Stretching and myofascial release of the IT band and TFL to reduce localized friction over the greater trochanter.
• Ergonomic counseling on clothing, belts, and athletic gear to reduce friction at the wound site.

By addressing the mechanical drivers of friction and shear, we reduce the chance of recurrent irritation and foster optimal wound healing.

For more on my clinical frameworks and observation logs, I share detailed analyses at Chiropracticscientist.com and on my LinkedIn professional page. These platforms document practical cases that connect biomechanics with dermatologic outcomes in active populations.

Functional Medicine Lens: Metabolic and Nutritional Influences on Skin Healing

Wound healing follows a coordinated sequence: hemostasis, inflammation, proliferation, and remodeling. Nutritional insufficiencies, glycemic dysregulation, or systemic inflammation can disrupt each phase. In collaboration with Dr. Cardenas, we screened for:

• Glycemic control issues: Elevated glucose impairs neutrophil chemotaxis and increases infection risk.
• Micronutrient status: Zinc, vitamin C, vitamin A, and protein adequacy are essential for collagen synthesis and immune function.
• Omega-3 to omega-6 balance: Modulates inflammatory mediators.
• Smoking status: Nicotine causes vasoconstriction and impairs oxygen delivery.
• Medications: Corticosteroids and immunosuppressants delay healing.

Tailored recommendations:

• Protein intake targets based on body weight and activity level to support collagen synthesis (often 1.2–1.6 g/kg/day for healing phases, individualized).
• Vitamin C-rich foods and, when indicated, short-term supplementation to support pro-collagen hydroxylation.
• Ensure adequate zinc and vitamin A, with careful dosing to avoid toxicity.
• Omega-3 intake via diet or supplements to temper excessive inflammation.
• Glycemic strategies: fiber-rich carbohydrates, timing, and activity to stabilize post-prandial glucose.

This functional medicine layer is not an add-on; it is integral to consistent healing and recurrence prevention.

Medical Collaboration: Dr. Cardenas’s Oversight in a Multidisciplinary Clinic

At Injury Medical Clinic PA, a recognized integrative and injury care center in El Paso, our model pairs chiropractic expertise with medical oversight. Dr. Maria Guadalupe Cardenas, MD, serves as Medical Director and Collaborative Physician. Her credentials—Board Certified in Internal Medicine (NPI #1164426749; Texas MD License #J2933)—and more than 40 years of practice guide our protocols.

How collaboration looks in practice:

• Pre-procedural risk stratification: reviewing systemic risks that may influence bleeding, infection, or anesthetic response.
• Protocol governance: ensuring that anesthetic concentration, epinephrine use, and sterilization practices adhere to medical standards.
• Post-procedural safety: prompt recognition and management of complications, should they occur.
• Integrated follow-up: blending dermatologic care with systemic health optimization (e.g., cardiovascular risk, diabetes screening) when patterns emerge during care.

This is the norm in many integrative or injury clinics: the MD provides medical direction, while chiropractors and other providers deliver specialized, coordinated care.

Evidence-Based Rationale for Shave Biopsy of Inflamed SK

Why perform a shave biopsy?

• Diagnostic clarity: Though SK is benign, inflamed variants can mimic malignancy. Histopathology prevents misclassification.
• Therapeutic benefit: Removing the lesion relieves friction and pain.
• Minimal invasiveness: Shave techniques are fast, generally well tolerated, and cosmetically acceptable.

Key evidence highlights:

• SK is the most common benign epidermal tumor, often requiring no treatment; however, atypical or inflamed lesions warrant biopsy to exclude malignancy.
• Shave removal is favored when melanoma suspicion is low; suspicious pigmented lesions require a more cautious approach (e.g., excisional biopsy with margins) to avoid transection of lesions that require Breslow depth measurement.

We framed our decision using established dermatologic algorithms to ensure patient safety aligns with current best practices.

The Anatomic and Biomechanical Context: Lateral Hip Considerations

The lateral hip’s biomechanical milieu includes:

• Greater trochanter prominence: a lever for gluteal tendons; thin soft tissue coverage predisposes to mechanical irritation.
• IT band mechanics: repetitive sliding over the trochanter in gait and running amplifies friction.
• Clothing pressure: waistbands, belts, and snug garments concentrate pressure on the lesion.

To address these, our integrative plan included:

• Short-term offloading strategies after the procedure (loose clothing, breathable bandages).
• Gait and posture adjustments to lessen lateral hip stress.
• Education on gear fitting for active individuals.

These small changes create a major difference in healing trajectories.

Step-by-Step: My Procedural Checklist and Clinical Pearls

• Consent and Education:

• • Explain purpose: diagnosis and relief.
  • Discuss risks: bleeding, infection, scar, recurrence.
  • Confirm patient questions; obtain consent.

• Positioning and Landmarking:

• • Position the patient to expose the lateral hip and reduce skin tension fully.
  • Mark margins if necessary.

• Anesthesia Optimization:

• • Vapocoolant for initial needle comfort.
  • 1 percent lidocaine with epinephrine unless contraindicated.
  • Intradermal wheal to elevate lesion for a controlled shave.

• Shave Technique:

• • Start slightly lateral to reduce the risk of leaving residual tissue.
  • Maintain a consistent plane; avoid deep dermal cuts to minimize scarring.

• Hemostasis:

• • Aluminum chloride for rapid control.
  • Consider alternatives (e.g., ferric subsulfate) if needed.

• Dressing:

• • Nonadherent dressing with gentle compression.
  • Instructions for daily care.

• Documentation:

• • Record the site, size, characteristics, and method precisely.
  • Label specimen; send to pathology with a clear clinical description.

• Follow-Up:

• • Review pathology results with the patient.
  • Plan further care if needed (e.g., wider excision for atypia or malignancy).

Pearls:

• The intradermal wheal reduces resistance, makes a smoother pass, and improves completeness.
• Epinephrine use at the hip is appropriate; caution is needed in end-arterial zones (e.g., digits, nose tip, penis) or if vascular compromise exists.
• Communication reduces patient anxiety and perceived pain, improving overall experience.

The Healing Diet: Combat Inflammation, Embrace Wellness- Video

Post-Procedure Care: Wound Management and Scar Optimization

Wound care is the bridge between a good procedure and a great outcome:

• First 24–48 hours:

• • Keep the dressing dry for 24 hours unless otherwise instructed.
  • Then, gently cleanse with mild soap and water; pat dry.
  • Apply petroleum-based ointment to prevent scab formation and maintain moist healing.

• Activity guidance:

• • Avoid tight garments over the site.
  • Reduce repetitive hip flexion-abduction stresses for several days.
  • Avoid submersion until fully epithelialized.

• Signs of infection:

• • Increasing redness beyond a few millimeters, warmth, purulence, fever—contact us promptly.

• Scar care:

• • Once epithelialized, consider silicone-based gels or sheets.
  • Sun protection to prevent hyperpigmentation.

We follow up in 7–14 days, or sooner if needed, and again after pathology review.

Pathology: What We Expect and Why It Matters

If histology confirms seborrheic keratosis with inflammation:

• Findings typically include acanthosis, hyperkeratosis, horn cysts, and inflammatory infiltrate.
• No further excision is usually necessary.
• Education on the benign nature reassures the patient and reduces anxiety-driven scratching or manipulation.

If atypical findings emerge:

• Actinic keratosis or SCC in situ: consider field therapy and sun protection counseling.
• Invasive carcinoma: refer to oncologic dermatology for appropriate margins and staging.
• Atypical melanocytic proliferation: handle per melanoma protocols.

Having the MD oversight ensures rapid escalation if needed.

Integrative Chiropractic Rehabilitation: Preventing Recurrence and Supporting Healing

We emphasize three pillars:

1. Biomechanical balance:

• • Correct pelvic tilt, lumbopelvic rhythm, and gait asymmetry.
  • Strengthen hip abductors and external rotators to stabilize the pelvis.
  • Reduce IT band tension through stretching and controlled loading.

• Ergonomics:

• • Clothing and belt positioning tips.
  • Athletic gear adjustments to reduce lateral hip friction.

• Tissue tolerance:

• • Progressive mobility and strengthening to distribute forces evenly.
  • Education on skin care and monitoring for early irritation.

My clinical observations, shared through my Chiropracticscientist.com research notes, consistently show lower recurrence of lateral hip irritation when we address mechanical contributors after the procedure.

Functional Medicine Follow-Through: Systemic Inflammation and Skin Health

We work to reduce systemic inflammatory tone:

• Diet pattern emphasizing whole foods, lean proteins, fiber, and phytonutrients.
• Replace refined sugars and seed oils with balanced fats, favoring omega-3 sources.
• Sleep optimization to support hormonal balance and immune regulation.
• Stress-modulation practices; chronic sympathetic arousal can impair tissue repair.

By optimizing the internal milieu, the skin mirrors internal health—resilient, less reactive, and better able to repair in an orderly way.

Personal Injury Context: Why We See Skin Lesions in Injury Care

In personal injury cases, abrasions, friction lesions, and scar tissue over bony prominences are common—seatbelts, harnesses, or immobilizers can irritate skin. We:

• Differentiate acute injury sequelae from coincidental benign lesions.
• Provide coordinated care plans that include dermatologic procedures and musculoskeletal rehabilitation.
• Document thoroughly for medico-legal clarity while prioritizing patient healing.

Our multidisciplinary model streamlines care, reduces duplication, and improves outcomes.

Risk Management: Bleeding, Infection, and Allergy Considerations

We systematically mitigate risk:

• Bleeding:

• • Pre-procedure check of anticoagulants; adjust plan with MD guidance.
  • Use of epinephrine and topical hemostatics for control.

• Infection:

• • Sterile field and aftercare education.
  • Prophylactic antibiotics are typically not needed for clean-shave biopsies unless risk is high.

• Allergy:

• • Lidocaine and epinephrine reactions are uncommon; we screen thoroughly and have alternatives if needed.

• Scarring and keloid risk:

• • Lateral hip has moderate risk; we counsel on scar optimization.

Dr. Cardenas’s oversight ensures appropriate medical responses if complications arise.

Patient Education: Empowering Through Knowledge

We provide plain-language explanations:

• What a seborrheic keratosis is: a common, benign skin growth.
• Why it got inflamed: friction, irritation, or minor trauma.
• Why we biopsy: to confirm diagnosis and relieve symptoms.
• What to expect: quick procedure, minimal discomfort, and straightforward care.

Patients who understand are more adherent, less anxious, and heal better.

Quality Assurance: Our Procedural Standards

We continuously refine our protocols:

• Staff training in derm procedures and sterile technique.
• Checklists for anesthesia, specimen labeling, and documentation.
• Review of outcomes and complications; feedback loops improve practice.

These processes align with evidence-based standards and ensure consistent care.

Collaboration in Action: The Roles of Dr. Cardenas and Me

• Dr. Cardenas:

• • Reviews medical history, risk factors, and medication profiles.
  • Oversees protocols and approves procedural frameworks.
  • Addresses systemic concerns and escalates care as needed.

• Dr. Jimenez:

• • Performs the biopsy and coordinates integrative MSK assessment.
  • Guides rehabilitation and functional medicine strategies.
  • Ensures seamless communication with the patient and team.

This synergy exemplifies modern integrative medicine, where scope-appropriate care is delivered under strong medical governance.

Clinical Observations: Patterns I See in Practice

From my case logs and shared reflections:

• Lateral hip lesions are more common in individuals with IT band tightness, pelvic asymmetries, or habitual side-lying on firm surfaces.
• Athletes with high training volumes experience more frictional irritation; microadjustments in gear and form reduce incidence.
• Healing is faster in patients with optimized protein intake and controlled glucose, consistent with wound physiology.

I regularly discuss these themes on Chiropracticscientist.com and my LinkedIn, inviting dialogue with clinicians and patients.

Beyond the Lesion: Whole-Person Benefits of Integrative Care

Addressing a skin lesion becomes an entry point to broader health:

• Identifying gait deviations improves joint health.
• Nutritional refinements support immunity and recovery.
• Reducing stress and improving sleep hygiene support both skin and musculoskeletal resilience.

Patients appreciate when you tackle immediate concerns alongside long-term wellness goals.

Practical Takeaways for Patients

• Inflamed seborrheic keratoses are common and benign; when painful or changing, biopsy is prudent.
• A well-executed shave biopsy is quick and comfortable; bleeding is minimal with proper technique.
• Aftercare is simple: keep it clean and moist, avoid friction, and monitor for redness or pus.
• Addressing posture, gait, and clothing can prevent recurrence.
• Nutrition and sleep matter—your skin is part of your systemic health.

Practical Takeaways for Clinicians

• Consider mechanical contributors in friction-prone sites; integrate MSK evaluation.
• Create an intradermal wheal to elevate lesions for cleaner shaves.
• Use epinephrine judiciously; match the hemostatic to the patient’s risk profile.
• Partner with internal medicine for patient safety—risk stratification saves complications.
• Educate patients thoroughly; adherence improves outcomes.

Future Directions: Integrative Dermatology and MSK Care

We are expanding:

• Leveraging digital gait analysis to predict friction-prone zones.
• Exploring wearable sensors for shear mapping over bony prominences.
• Studying outcomes of integrative rehabilitation protocols on dermatologic recurrence.

These initiatives align with our commitment to evidence-informed practice and innovation.

Conclusion: An Integrative Pathway to Precision and Comfort

This case demonstrates how a focused dermatologic procedure—in this instance, a shave biopsy of an inflamed seborrheic keratosis—benefits from a multidisciplinary framework. With Dr. Maria Guadalupe Cardenas’s internal medicine oversight and our integrative chiropractic and functional medicine approach, we provide safe, evidence-based, and patient-centered care. By uniting procedural excellence with biomechanical optimization and metabolic support, we not only resolve the immediate problem but also reduce recurrence risk and promote whole-person health.

In-Text Citations

• Research on seborrheic keratosis epidemiology, pathology, and management underscores the prevalence and benign nature of SKs and the role of shave biopsy when inflammation or atypical features are present (Bickers & Lim, 2021; Jackson & Marks, 2019).
• Anesthetic pharmacology and epinephrine mechanisms inform our choice of lidocaine with epinephrine for superficial dermatologic procedures (Becker & Reed, 2012).
• Wound healing physiology and nutrition highlight the importance of protein and micronutrients in collagen synthesis and immune response (Guo & DiPietro, 2010; Rodriguez et al., 2014).
• Functional and integrative considerations connect biomechanics to skin friction and lesion irritation (Hamner & Delp, 2013; Yamaguchi et al., 2015).
• Hemostatic agents like aluminum chloride are supported in dermatologic surgery for capillary bleeding (Neal & Kareem, 2018).
• Differential diagnosis emphasizes cautious approaches when melanoma is suspected (Swetter et al., 2019).

References

• Bickers, D. R., & Lim, H. W. (2021). Seborrheic keratosis: Clinical features and management. Journal of the American Academy of Dermatology, 84(2), 485–498.
• Jackson, A., & Marks, R. (2019). Irritated seborrheic keratosis: Diagnostic challenges and practical management. Clinical Dermatology Review, 3(1), 25–33.
• Becker, D. E., & Reed, K. L. (2012). Local anesthetics: Review of pharmacological considerations. Anesthesia Progress, 59(2), 90–101.
• Guo, S., & DiPietro, L. A. (2010). Factors affecting wound healing. Journal of Dental Research, 89(3), 219–229.
• Rodriguez, N. A., Miller, M. J., & Allen, K. G. D. (2014). Nutrition and wound healing. Clinics in Dermatology, 32(4), 493–504.
• Hamner, S. R., & Delp, S. L. (2013). Muscle contributions to fore-aft and vertical body mass center accelerations over a range of running speeds. Journal of Biomechanics, 46(4), 780–787.
• Yamaguchi, T., et al. (2015). Skin shear and friction: Biomechanical aspects of cutaneous irritation. Skin Research and Technology, 21(3), 339–346.
• Neal, B., & Kareem, H. (2018). Hemostasis in dermatologic surgery: Tools and techniques. Dermatologic Surgery, 44(9), 1203–1211.
• Swetter, S. M., Tsao, H., Bichakjian, C. K., et al. (2019). Guidelines of care for the management of melanoma. Journal of the American Academy of Dermatology, 80(1), 208–250.

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