Objective To analyze the effect of narrowband ultraviolet B (NB-UVB) irradiation combined with auto-epidermal grafting on skin lesions and pigmentation recovery in patients with vitiligo. Methods A total of 82 patients with vitiligo admitted to the Air Force Hospital of the Eastern Theater Command of the Chinese People's Liberation Army from January 2022 to December 2023 were selected as the research subjects, and they were divided into the control group (n =41) and the observation group (n =41) by the random number table method. The control group was treated with NB-UVB, and the observation group was treated with auto-epidermal grafting on the basis of the control group. The clinical efficacy, quality of life, aesthetic indexes and advese reactions were compared between the two groups. Results The total effective rate of treatment in the observation group was 97.56%, which was higher than 80.49% in the control group (P <0.05). After treatment, the skin lesion area in the observation group was smaller than that in the control group, and the pigmentation score and repigmentation rate were higher than those in the control group (P <0.05). After treatment, the scores of behavior, shame and participation restriction in the observation group were lower than those in the control group (P <0.05). The incidence of adverse reactions in the observation group was 7.32%, which was higher than 4.88% in the control group, but the difference was not statistically significant (P >0.05). Conclusion NB-UVB combined with auto-epidermal grafting has a definite treatment effect on vitiligo. It can effectively reduce the skin lesion area of patients, improve skin pigmentation, has high application safety, and can promote the improvement of the quality of life. It is recommended for clinical application.