My Journey in Vitiligo and Patient Care beyond Shores by Dr Anantha Prasad Holla- Consultant Vitiligo Specialist, Founder and Director of MelanoSite and VITALS klinic

1. My journey in vitiligo and patient care beyond shores
Dr. anantha prasad holla p
Founder director melanosite and vitals
Dr. anantha prasad holla p
Founder director melanosite and vitals

2. introduction
• Reluctant Dermatologist with decade of expertise in vitiligo treatment.
• MelanoSite - based at New Delhi and Bengaluru doing exclusive vitiligo care.
• Vitiligo – life altering, multifactorial skin condition with white patches having
psychosocial consequences.

3. Why Vitiligo?
Every Doc Has
a Day!!!!
Mera Number Ayega!!!!!

4. Why vitiligo?
• Opted for dermatology only for dermato-surgery.
• Vitiligo treatment - Surgical management one of the option.
• Cell transplantation – Lucky to be involved with evolving phase of this
treatment.
• Adamantly wanted brand Dr. Holla!!!! – exclusive vitiligo care.

5. Vitiligo at pgimer, CHANDIGARH
• In March 2007 got initiated to vitiligo surgery – Ultra thin skin grafting.
• Got experience in all kinds of vitiligo surgeries.
• Accumulated opportunities – giving the expertise.
• Thesis in Cell transplantation- first started working in someone’s thesis
despite knowing that I will not get the credit.

9. CELL TRANSPLANTATION- INITIAL YEARS
• My thesis in modification of cell transplantation : Spent more time in
doing cell transplantations than learning dermatology.
• 5 presentations in reputed conferences. 3 presentations in international
conferences and 2 reputed scholarships.
• Once being told ‘ disgrace to the institute and my work in vitiligo can
be done by peon of department’.

11. Vitiligo thesis
• Got my own thesis in cell transplantation.
• Overnight change in topic ‘ cultured melanocyte transplantation’ to
‘modified procedure of non-cultured epidermal suspension
transplantation’
• However, did more cases than required in thesis – giving importance to
cell preparation, improvising graft taking and treating all difficult areas.

17. Vitiligo in private practice
• Dream was doing something in Dermatosurgery and Vitiligo.
• Initial struggle in 2010-2011- from just a head count at medical college to
consultant vitiligo specialist.
• Convincing patients and doctors: I can do vitiligo surgery and give result

18. • Getting the reagents and solutions : transition from lab to OT.
• ?Place of practice- Establishing Vitiligo Centre.
• To prove that cell transplantation as an effective option even in
difficult areas in private practice .

19. Destiny Delhi
• One Clinical trial opportunity took me to New Delhi -bargained for 1
week per month window for vitiligo practice.
• Started doing procedures at New Delhi and Mangalore.
• 150 sq ft chamber in East Delhi in 2012 → 600 sq ft clinic in South Delhi in
2013 → 3000 sq ft exclusive centre in 2016 in ‘ skin street’!!!!

20. • Initially focussed only on cell transplantation for referral patients.
• Faced ‘ We can also do it but it is useless’ situation.
• Then started focusing on Medical management – pool of patients
gradually going for procedure in a stepwise manner.

21. Strategies that worked

22. Individualized interactive protocol
• Treatment depending on type, site, size, stability of vitiligo, previous
treatments and patient parameters.
• Need Vs Want (Individualized Vs Customized )
• Interaction – involvement of patient, understanding the disease and
treatment, counselling and regular follow up.

23. Understanding the Puzzle of vitiligo
•
Vitiligo
Depigmentation
Disorder
Transition Phase
Repigmentation
Disorder

24. Damag
ed Cell
Genetic
Susceptibility
↑ Free Radical
Production
↓Free Radical
Neutralization
Hyper active
Immune
system
Immune cells
against
melanocytes
Autoimmune
destruction
Vitiligo
Vit D
deficiency
Deficiencies
Life style, Environmental Factors, Stress, Deficiencies and Derangements
Need not be hereditary or familial

25. No Cell
Dama
ge
Genetic
Susceptibility
↓ Free Radical
Production
↑Free Radical
Neutralization
Normal
Immune
system
Immune cells
against
melanocytes
Autoimmune
destruction
Vitiligo
Normal Vit D
Life style changes, diet modifications, relaxation, skin care and
tackling of deficiencies and derrangements
No Triggers
which
aggravate the
susceptibility
Nutritional Supplementation

26. Target Based stepwise Treatment
• Arresting Phase – target cell destruction and improve cell survival.
• Pigmentation with Medical mode- cell stimulation and increased cell
survival.
• Cell Transplantation- replenishment and replacement of cells.
• Maintenance: Maintaining good results with minimal treatment.

27. Pigme
ntation
Phase
Arresti
ng
Maint
enanc
e
Phase
Refra
ctory
Phas

28. Seven ways vitiligo fight
1. Treatment.
2. Life Style Management.
3. Diet Modification.
4. Skin Care.
5. Stress Management.
6. Attitude Management.
7. Involvement.

29. Query- patient handling
• Prompt Query Handling- mails, messages and calls.
• Counselling and Convincing.
• Consultation First.
• No Guarantee, No promise and No Estimate or Quote.
• Strict Follow ups- Individual Whatsapp Groups and backend team to
take updates and guide patients.

30. Online marketing
Anvita for
Web
Marketing
Facebook
Page
LinkedIn
Profile
Organic
reach

31. No ‘cure in vitiligo’
• Keeping medical ethics in mind never promoted ‘ cure in vitiligo’.
• Vitiligo is Treatable.
• Remission and Relapse.

32. Product is better than the package!!!!
• No free consultations – in genuine cases nominal
charges.
• Trusting and Valuing our approach and
explaining the same.

33. Team building
• Motivated Staff: Preference to persons directly and
indirectly affected by vitiligo.
• Pride in being part of patient’s fight with vitiligo.
• No compromise with vision and mission of our vitiligo
care.

34. Triage- grouping
Type A
Convince
d
Type A
Convince
d
Type B
Confused
Type B
Confused
Type C
Counter
Productive
Type C
Counter
Productive
Difficult
Vitiligo
Vs
Difficult
Patient
Difficult
Vitiligo
Vs
Difficult
Patient

35. Result oriented approach
• Results are visible!!!!.
• Strict patient selection.
• Results vs Number.
• High success rates.

36. Innovations and modifications
• Improving constantly
 to get faster results.
 to get better results.
 to get consistent results.
 to get long lasting results.

37. Medical management
• Immunomodulation/suppression.
• Increased Cell Survival.
• Mild and consistent cell stimulation.
• Prophylactic approach to prevent relapse.

38. Cell transplantation
• Non-cultured epidermal cell suspension transplantation (NEST) with recombinant
reagent.
• Non-cultured Follicular Suspension Transplantation (FoST).
• Combined Cell/Follicular &Epidermal Suspension Transplantation (FEST).
• Artificial Reservoir Technique (ART).

39. Tele-vitiligo approach
• Medical Tourism -
Affordability (but it was not the only reason).
Availability of better vitiligo care.
- advanced options not present in developed countries.
• Tele Vitiligo – Online Consultation.
• Vitiligo is psychosocially stigmatizing condition even in developed countries.

40. Handling failures
• Analyzing the failures.
• Explaining the possible reasons and remedies.
• Achieving success in failure using modifications in the treatment.
• Patients continuing treatment despite having failure, with a trust that only we can
help them to overcome it.

42. Cell transplantation

64. Medical management

74. challenges

75. Vitiligo – chronic condition
• Unpredictable course and response.
• Immense psychosocial impact : Heavy baggage.
• Long term and consistent involvement needed – time and money.
• Relapse possible any time even if 100% cleared.
• Recipient Dominance: Putting sensitive cells in hostile area (Unlike hair transplantation where
resistant follicle put in hostile area).

76. Established beliefs
• Vitiligo Not Treatable.
• Allopathy can not treat vitiligo or it will aggravate.
• Allopathy has only side effects – side effect phobia.
• Alternate systems don’t have side effects- continued use of treatment
even if no effect.

77. Washing dirty laundry
• Modified Vitiligo – Colour and Texture mismatch.
• Failed or mismanaged cases – Damaged Psyche.
• Handling referrals
Enhanced expectations.
False hope in wrong cases.
Continuation of frustrations.

78. Previous skin grafting + Psoralen Use

79. Post burn after psoralen use

80. Colour mismatch after psoralen use

81. Colour and texture mismatch punch grafting

82. Cobble stone appearance due to punch grafting

83. Damaged skin due to psoralen

84. Failed skin grafting

85. Unrealistic expectations
• Stable Patient Vs Stable Vitiligo.
• Fine Tuning Expectations.
• No Walk in procedures.
• Only convincing and counselling – no confusions

86. Cosmetic condition vs cosmetic solution
• Although vitiligo is a cosmetic condition/problem, solution is not
cosmetic.
• It needs involvement and dedication of patients.
• Justifying rigid system- can not have flexible approach like a cosmetic
centre or spa

87. Other challenges
• Mastering Finance.
• Handling Human resources: Managers Vs Damagers
• Handling Negativities – exhausting for staff involved in patient counseling.
• Innovations in private practice.

89. Present Status
• Two Clinics and One dedicated office for backend support.
• Both clinics equipped with providing advanced medical
management, phototherapy and cell transplantation.
• 20 Dedicated staff for patient care.
• 3000 Medical Management and 5000 Cell Transplantation Procedures
in patients from all over the globe.

90. 0
3000 sq cm area treated in one session

91. VITILIGO At EMORY
• Adjunct Faculty at Emory University
Medical School, Atlanta, USA.
• Associated with cell transplantation
project in segmental vitiligo.
• Vitiligo Awareness Programs in association
with Vitiligo Bond Inc
• Started Recombinant Reagent based
procedure for this project.

92. vitals
• VITALS KLINIC – Vitiligo, Injectables, Transplantation, Aesthetics, Lasers
and Skin Surgery/Skin Care.
• Group Practice in Niche Dermatology – Like minded dermatologists
with special interest in one area.
• For Vitiligo – Screening centers and medical management.

94. future
• R&D facility in vitiligo/skin care : Research in cellular level to Clinical
Trials.
• Innovations to find newer options
 Medical Management to focus immunomodulation, decreased cell death and increased cell survival
and proliferation.
 Newer phototherapy devices.
 Newer techniques in cell transplantation especially cell delivery system.
• Expansion (With in and Outside India) : collaborations, training, kit
based cell transplantations and ‘end to end’ vitiligo care assistance.

95. thanks
• Launching soon
 www.vitiligoholla.com
 www.vitiligoholla.info
 www.vitalsbangalore.com