Background. In patients with extensive vitiligo, depigmentation therapy is often preferred over attempts to restore skin color. Bleaching creams sometimes fail to permanently depigment the skin, leaving disfiguring pigmented patches. This recalcitrant pigmentation may be treated with Q-switched laser technology.

Objective. The objective was use the Q-switched alexandrite laser to treat recalcitrant pigmentation after unsuccessful attempts at total-body depigmentation for vitiligo.

Methods. We have attempted to destroy the remaining melanin pigmentation in a 68-year-old woman with vitiligo by using selective photothermolysis from a Q-switched alexandrite laser.

Results. Excellent results were achieved after 10 treatment sessions, with no recurrence of pigment after 1 year of follow-up.

Conclusion. The Q-switched alexandrite laser was used successfully and safely in a vitiligo patient with recalcitrant pigmentation after unsuccessful depigmentation therapy and may prove useful in other such cases.