Objective To explore the clinical effect of ffre needle combined with 308 nm excimer laser in the treatment of vitiligo under dynamic dermoscopic assessment. Methods A total of 60 patients with vitiligo diagnosed and treated in our hospital from January 2023 to April 2025 were selected as the research subjects, and they were divided into the control group and the observation group by the random number table method, with 30 patients in each group. The control group was treated with 308 nm excimer laser, and the observation group was treated with ffre needle combined with 308 nm excimer laser. The clinical efffcacy, vitiligo lesion area, vitiligo regression time, ffrst pigmentation time, skin lesion repigmentation rate, skin lesions observed by dermoscopy and naked eye, adverse reaction rate were compared between the two groups. Results The total effective rate of the observation group (93.33%) was higher than that of the control group (80.00%) (P<0.05). The vitiligo lesion areas of the two groups after 3 and 6 months of treatment were smaller than those before treatment, and those of the observation group were smaller than those of the control group (P<0.05). The vitiligo regression time and ffrst pigmentation time of the observation group were shorter than those of the control group (P<0.05). The skin lesion repigmentation rates of the observation group after 3 and 6 months of treatment were higher than those of the control group (P<0.05). The proportions of pigment island formation, telangiectasia, perilesional pigmentdarkening, perifollicular pigment residue and vascular morphology changes observed under dermoscopy in the two groups were higher than those observed by naked eye, and those in the observation group were higher than those in the control group (P<0.05). There was no statistically signiffcant difference in the incidence of adverse reactions between the observation group (13.33%) and the control group (16.67%) (P>0.05). Conclusion The effect of ffre needle combined with 308 nm excimer laser in the treatment of vitiligo is superior to that of single 308 nm excimer laser. It can shorten the vitiligo regression time and ffrst pigmentation time, improve the skin lesion repigmentation rate, and will not increase the incidence of adverse reactions, with good application safety and effectiveness.