Host: Very common condition unfortunately, the kids go to school, and they just start scratching the hair and someone see this little blackish whitish little thing, but that when they try to blow it off, it doesn’t go; it is not dandruff, and the school says, you have got to go and see your doctor because it could be something that everybody can get. Can you little bit talk about lice?
Dr. MD Koom: Alright, actually the pediatrician see this scabby lice more than you, but the pediatrician see more lice than I do, it is like you guys see it first. The treatments have evolved, the joke is it is probably going back to the original because it has to do with the --.
Host: Do you know the difference, if you see something on the hair that you can’t remove easily?
Dr. MD Koom: Okay, two things. A) You look for something moving; if you find, a lot of times they washed out the ones are moving. So what you do is it’s an egg shaped that basically is sort of on the other side of the hair toward the scalp because they like heat and it’s oblong, and tends to be whitish to sometimes slightly brown.
Host: It’s hard to get off.
Dr. MD Koom: It’s hard to get off.
Host: And do you have people who trying blow it off.
Dr. MD Koom: But you can’t blow it off, they stick like raisin.
Host: But, dandruff, you can blow away.
Dr. MD Koom: Dandruff, you can blow away on the hair.
Host: So, if you see that, what would be the best approach?
Dr. MD Koom: Over-the-count of stuff it probably works for upwards 85% of people, so the mix products work for 85% of people.
Host: Alright. What if they do all that?
Dr. MD Koom: The problem is, is not that they have bugs anymore, because the mix is probably effective and killing 85-90%, the problem is that you have the itching that doesn’t go away, and the reason for the itching is the bugs aren’t there anymore, but you’ve got persistent itching, because you’ve got inflammatory reaction that is secondary. So step one - kill the bug, step two - get rid of the eggs, and step three - calm down the inflammation that is there.
Host: How would you do that?
Dr. MD Koom: To get rid of the bugs you could use the over-the-count stuff that you could use mix. So if mix is not an option or it doesn’t work then you’re looking at permethrin, okay, or you’re going back to --
Host: If all that is done and it keeps coming back?
Dr. MD Koom: Then you’re going to some really, really messy stuff, you’re looking at like sulfur and Vaseline type and it is a real mess because you’ve got to leave it on like for 12 hours and try to suffocate the lice.
Host: Is there any merit of shaving the head?
Dr. MD Koom: No, because there are pills you could take if you had to. I mean it’s not mainstream use and it’s not officially approved for it, but any ectoparasite or lice, scabies etcetera will respond to Ivermectin.
Host: And then we’ll look if you’re rich or poor.
Dr. MD Koom: Yeah, it doesn’t make a difference, although probably it’s more Caucasian than Black.
Host: They don’t care.
Dr. MD Koom: They don’t care, but it’s more Caucasian they like what they --
Host: They don’t mind being stuck in -- where do people get it. It doesn’t mean they’re filthy.
Dr. MD Koom: No, it doesn’t; it is just the kids picked that up because it’s basically kindergarten or a second grade, where the kids are really close contact.
Host: Is there anything that is resistant type?
Dr. MD Koom: Yeah, there is even Kwell probably has upwards 2-3% resistance, right.
Host: Is there narrative doing, wash the hair with a sub or real type of shampoo?
Dr. MD Koom: No, the alcohol works reasonably well to loosening the eggs, okay.
Host: Or vinegar.
Dr. MD Koom: Vinegar works reasonably well to loosening the eggs.
Host: This is a fine common --
Dr. MD Koom: Yeah actually you’ve actually -- I’ve done this because I had personal experience with this for like 20 years ago. I actually just had there till they pulled the individual hairs and stuff them out, because they do not come off that well. I don’t know if it’s still around, there was Olbide which was a product, then there was Hair123 which is a memorable product that suppose to loosen the hairs, and then I am a big fan, they’re not cutting the hair off but like get them out with anything what you can, naturally or medicine in terms of loosening the egg, and then sit there. It’s going to take you an hour or two but like just pull out the individual hairs and snip those hairs right below to eggs.
Host: It’s a very tough thing to loosen sometimes.
Dr. MD Koom: Yeah, they basically stick.
Host: That’s washed off.
Dr. MD Koom: But washing it ten times with the standard shampoo, even a medication shampoo will give the same results.
Host: So in other words, you can’t remove the individual --
Dr. MD Koom: If you look bugs, individual eggs, chemically first, mechanically second, and then if this keeps still itching then you got to treat them medically as if it has X of them on the scalp.
Host: And there are some things you can do with that, that dermatologist has got that you conventionally can not.
Dr. MD Koom: Yeah, you can use the internal drug; you can use the topical drug. If it’s an elder kid you can eject some medicine. I am not a big fan of sticking needles in kids, so if you’ve got to more than one needle at a time, because the kid will never want to talk to you ever again. That’s like when I stick -- which is like an allergic hair loss pattern. I try very hard not to inject little kids, because the kid is not going to want to come to me after the first visit, so I try anything topical I can.
Host: But eventually we have -- people get terrific control.
Dr. MD Koom: Yeah, and if you are really, really stuck in the worse case scenario if you had to, you could use basically the CDC drug, although those are off labels, so you could use Ivermectin. So for resisting case of the scabies I use Ivermectin then.
Host: Thank you very much.
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