Background: Vitiligo is an acquired pigmentary disorder of unknown etiology that affects up to 1% of the general population of all skin types. It is a multifactorial disorder. There are numerous medical and surgical treatments aimed at repigmentation. Microneedling is a minimally invasive procedure that uses fine needles to puncture the epidermis. The indications for microneedling therapy have grown significantly and it is becoming a widely used treatment in Dermatology. Aim of Study: To study the clinical and histological efficacy of combined NB-UVB phototherapy and microneedling versus NB-UVB phototherapy in the treatment of vitiligo. Patients and Methods: Twenty patients were divided into two Groups (A & B), each of 10 patients. Both groups were matched regarding age, sex, skin type and have a depigmented patch at the same corresponding site. Group A was subjected to microneedling with dermapen at one depigmented patch followed by NB-UVB phototherapy sessions twice weekly for three months. Group B was subjected to NB-UVB phototherapy sessions twice weekly for three months. Two Skin biopsies one before and one after the therapy were taken for immunohistochemical examination by HMB 45. Results: The mean percentage of improvement was significantly high in Group A (48.50% ± 26.46) than Group B (20.0% ± 19.58). In Group A 20% showed mild improvement (G1), 20% showed moderate improvement (G2), (40%) showed good improvement (G3) and 20% showed excellent improvement (G4). In Group B 30% showed no improvement, 50% showed mild improvement (G1), 10% showed moderate improvement (G2) and 10% showed good improvement (G3). There was statistically significant difference between both groups (p=0.027*). Immunohistochemical changes revealed marked expression of HMB45 in Group A more than Group B, the mean of color intensity in Group A was 0.05 ±0.04 and a median of 0.03