Vitiligo is autoimmune-induced skin depigmentation. Phototherapy is commonly used as the basic treatment for vitiligo; however, its curative effect is limited in some cases of refractory vitiligo. This study aimed to evaluate the clinical efficacy and safety of upadacitinib combined with a 308 nm excimer laser (308 nm EL) for treating refractory vitiligo with moderate-to-severe atopic dermatitis (AD). We analyzed the treatment of 19 Chinese patients with skin diseases and found that sex, disease duration, and skin type did not affect repigmentation, whereas age was negatively correlated with repigmentation. After 4 months of therapy, the overall remission degree of the vitiligo area severity index (VASI) score reached 55.00%, and the last 2 months were better than the first 2 months. The curative effect of vitiligo on the face and neck was better, with an improvement of > 70.00%, followed by the torso, arms, and legs. The VASI scores of the hands and feet were the worst, especially the feet which scored only 28.00%. The average improvement in the SCORing of AD (SCORAD) and dermatology life quality index (DLQI) scores was 41.89% and 49.12%, respectively. No serious adverse events were observed. Overall, upadacitinib combined with 308-nm EL showed promising clinical value for the treatment of refractory vitiligo.