Repigmentation of vitiliginous facial area after Q-switched Nd-YAG laser therapy for depigmentation: Is it a case of true reverse Koebner phenomenon in vitiligo?

The patients with universal vitiligo and residual pigmented patches usually do not benefit from available repigmenting methods and are better scheduled for depigmentation by medical, laser, and or freezing procedures. A 37-year-old lady with universal vitiligo and remaining pigmentation in the left anterior chest wall, both ventral forearms, and diffuse mottled depigmentation of the face was scheduled for facial depigmentation by 532 nm Q-switched Nd-YAG laser. All residual pigmented facial areas were treated uniformly. Two months after laser therapy, we paradoxically observed considerable repigmentation of the treated areas with only some remaining scattered and round depigmented patches. Through an unknown mechanism, a true reverse Koebner phenomenon with its resultant repigmentation rather than depigmentation was observed in our patient.