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Vitiligo is a progressive disease characterized by depigmentation of the skin due to the decrease in the number or the absence of melanocytes, often starting in the perioral region. This study aims to identify the main histopathological findings that support a better diagnostic-therapeutic approach. The search was performed in Pubmed database using descriptors: vitiligo, histopathology, pathology and inflammatory infiltrate. It resulted in 14 works published in the last 10 years, of which 3 were selected, observing the adopted criteria. The absence of melanocytes is one of the main findings that characterize vitiligo. However, immunohistochemistry showed that 12% of 100 biopsies had 7.68 melanocytes/mm², which were hypofunctioning, although viable. Compared to nevus depigmentosus, vitiligo has more hypopigmentation and lesional dermal inflammation compared to normal perilesional skin. Perifollicular lymphocytic inflammatory infiltrates (PLIN) may indicate disease activity: patients with active disease and black hair within the lesion have dense infiltrates, whereas in stable cases when the Koebner phenomenon is absent, this site has slight inflammation. Histopathological findings can confirm diagnosis in dubious cases and clarify the use of topical corticosteroids as a therapeutic alternative. Furthermore, the density of the PLIN stratifies disease activity. Immunohistochemistry has shown to be promising, identifying remaining melanocytes and enabling new therapeutic research. [ABSTRACT FROM AUTHOR]

Considering the heterogeneity of clinical and histopathological presentation of vitiligo and other depigmented lesions, this study aims to study the morphological criteria for diagnosing vitiligo in skin and perioral in a local cohort of patients. 25 skin and perioral biopsies diagnosed as suggestive of vitiligo, between the years 2009 and 2021, and performed by a private pathology laboratory in Southwest Goias, were analyzed. After histological processing, slides were analyzed considering morphological parameters described in the literature. Inflammatory infiltrate criteria, both perivascular and in the dermis and epidermis, can be used as indicative of the inflammatory nature of the depigmentation, helping to differentiate it from other entities such as nevus depigmentosus. Other findings such as degeneration of the basal layer, spongiosis, basal vacuolation, dyskeratosis, hyperkeratosis, thinned epidermis and absence of dermal papillae can also be used as criteria indicative of vitiligo lesions. Despite identifying criteria suggestive of the disease, the study demands the expansion of the sample for a better characterization of the findings. Furthermore, the importance of correlating anatomopathological findings with clinical information is reinforced to ensure greater data reliability. [ABSTRACT FROM AUTHOR]