Objective To investigate the effect of 1% pimecrolimus cream combined with 308 nm excimer light on repigmentation in patients with facial stable vitiligo. Methods A total of 135 patients with facial stable vitiligo admitted to the Department of Dermatology, Kunshan First People’s Hospital from August 2023 to July 2025 were selected as the research subjects. According to the random number table method, they were divided into the medication group, the phototherapy group and the combination group, with 45 patients in each group. The medication group received topical 1% pimecrolimus cream alone, the phototherapy group received 308 nm excimer light irradiation, and the combination group received topical 1% pimecrolimus cream combined with 308 nm excimer light irradiation. The repigmentation status, lesion area improvement, Dermatology Life Quality Index (DLQI) score and adverse reactions were compared among the three groups. Results At 3 and 6 months after treatment, the total effective rates of repigmentation in the combination group were higher than those in the medication group and the phototherapy group (P <0.05). At 3 and 6 months after treatment, the lesion area improvement rates in the combination group were higher than those in the medication group and the phototherapy group (P <0.05). At 3 and 6 months after treatment, the DLQI scores in the combination group were lower than those in the medication group and the phototherapy group (P <0.05). There was no statistically significant difference in the incidence of adverse reactions among the three groups (P >0.05). Conclusion 1% pimecrolimus cream combined with 308 nm excimer light can reduce the leukoderma area of patients with facial stable vitiligo, improve skin-related quality of life, and achieve favorable repigmentation efficacy, with good safety. It is suitable for clinical application.