PROPOSAL TITLE: Laser hair removal as a treatment modality in pilonidal disease: Providing access to care in the East Bay and beyond
PROJECT LEAD(S): Alicen Kershaw, NP, Layna Blurton, NP, Kreev Joundi, RN, Dr Sunghoon Kim
EXECUTIVE SPONSOR(S): Christopher Newton, MD
ABSTRACT: Pilonidal disease, characterized by the formation of cysts or abscesses in the sacrococcygeal area, primarily affects young adults and often leads to recurrent infections, discomfort, and significant quality-of-life issues. Conventional treatments, including antibiotics and surgery, have high recurrence rates, especially among adolescents, contributing to long-term health and social challenges. This proposal explores the use of laser hair removal as a preventive treatment to reduce recurrence and alleviate disease burden. Laser hair removal targets hair follicles in the affected area, thereby minimizing hair entry into the cystic space and preventing further cyst formation. While traditionally a cosmetic procedure, recent shifts in insurance coverage and clinical evidence suggest that laser hair removal can serve as an effective, low-risk adjunct to surgery in managing pilonidal disease. This initiative aims to provide laser hair removal treatments at the Oakland Pediatric Surgery Clinic, targeting adolescents with pilonidal disease, to reduce the need for surgical interventions by at least 50%. By addressing access disparities and offering this treatment as part of a comprehensive care approach, the project seeks to improve patient outcomes, reduce healthcare costs, and increase overall quality of life for patients. The intervention will be assessed through patient surveys and surgical recurrence rates, with a focus on equity in treatment access.
TEAM: Alicen Kershaw, NP, Pediatric Surgery and Trauma APP Layna Blurton, NP, Pediatric Surgery and Trauma APP Kreev Joundi, RN, Pediatric Surgery Clinic RN
Sunghoon Kim, MD, Pediatric Surgeon
PROBLEM: Laser hair removal is an effective treatment option for pilonidal disease, but there is little access to this treatment modality for patients in the Oakland Pediatric Surgery referral area
- Pilonidal disease is a painful condition characterized by the formation of a cyst or abscess in the sacrococcygeal region, typically associated with hair, debris, and skin cells. It commonly occurs in young adults and can lead to recurrent infections, discomfort, and chronic pain. Pilonidal disease can be debilitating in the adolescent population, leading to long term dependence on caregivers, social withdrawal, and overall reduced quality of life. Treatment options for pilonidal disease vary based on the severity of the condition. For acute infections, antibiotics are prescribed, and surgical intervention may be necessary to drain abscesses or excise the cyst. However, recurrence rates are notable, prompting the exploration of alternative treatment modalities.
- Laser hair removal is an effective preventative measure for pilonidal disease. The rationale behind this treatment is that reducing hair density in the affected area may decrease the risk of cyst formation or recurrence by minimizing the introduction of hair into the cystic space. Laser hair removal targets hair follicles, which can lead to significant and permanent hair reduction over time.
In the past, laser hair removal has been considered a cosmetic procedure, therefore only accessible to those who could afford to pay out of pocket, thus creating a wide socioeconomic disparity in this disease. However, insurance companies have started to reimburse for this necessary procedure in the face of data exemplifying the reduction in recurrences in the disease process with the use of laser hair removal.
TARGET: The goal is to reduce the burden of pilonidal disease by decreasing the need for surgical intervention in the adolescent population by at least 50% in the East Bay area and beyond by providing laser hair removal treatment. This would be measured by the rate of healing or improvement after patients undergo laser hair removal treatments and by rate of need for surgical intervention/recurrence with surgical intervention. Healing is defined as the absence of discharge or pain without any clinical documentation of pits, sinuses, or inflammation in the sacrococcygeal area. Improvement is defined as decrease in symptoms (pain, discharge, interference with work or school) but without complete resolution of pits, sinuses, inflammation. Symptoms would be measured pre and post intervention using a patient survey. The expected benefits would be decreased burden of disease, a decreased need for surgical excision and lower recurrence rates.
GAPS: Pilonidal disease has historically been a complex and difficult disease process to treat with a high recurrence rate even after multiple surgical interventions. Compliance rates with current hair removal treatments such as chemical dilapidation and shaving are low as both have side effects and require both long term and frequent intervention. Laser hair ablation has been shown to be the most effective long-term strategy for the treatment of pilonidal disease. Laser hair removal began as a cosmetic intervention in health care and therefore has been unavailable to lower socioeconomic populations thus creating a major gap in access to care despite this being the gold standard for treatment in pilonidal disease. Currently, there is limited access to this treatment for patients with pilonidal disease in the UCSF Benioff Children’s Hospitals catchment area as UCSF does not offer this treatment.
INTERVENTION:
Our proposed intervention is to implement laser hair removal at the onset of diagnosis of pilonidal disease as this has been well documented to decrease disease burden over time and reduce necessity of surgical interventions.
Patients will undergo hair dilapidation treatments monthly until hair removal is achieved. The exact number of treatments varies by patient but averages 5.
We will use a validated patient survey tool as well as number of surgical interventions for each patient as our measurable forms of improvement with our specified treatment modality and will specifically include race and socioeconomic status in the surveys to ensure equitable treatment for the whole of our patient population.
Our practice setting is the pediatric general surgery clinic where we will provide laser hair removal treatment at a minimum of 3 days a week with the goal to increase to 5 days a week as we have an increase in patient volume.
Our targeted population would be any adolescent under the age of 21 with the initial diagnosis of pilonidal disease or pilonidal abscess referred from the community or emergency department or self-referred.
The biggest barriers to implementation are the initial capital cost of obtaining a laser, as well the cost of training staff members to perform the treatment. Other barriers are the lack of an established 240v electrical outlet (required for laser hair machine).
Another potential barrier is obtaining reimbursement from insurance companies as laser hair removal therapy has been considered cosmetic in the past; however, the pediatric surgery community has been working towards increasing insurance coverage for laser hair removal in pilonidal disease and reimbursement rates have been improving overall.
Side effects of laser hair removal include blisters, burns, muscle spasms, fatigue, nausea, and headaches. Long term effects can include hypopigmentation, hyperpigmentation, scars, and other permanent skin blemishes. However, with appropriately trained staff and quality medical grade equipment, laser hair removal is considered safe and has minimal side effects.
PROPOSED EHR MODIFICATIONS
Create a template for documenting the treatment.
Create a template for the initial H&P that justifies the need for the laser hair
removal
Create an EHR Report to track the number of treatments, number of recurrences,
need for surgical intervention
