Objective To explore the effect of Fuling Chuanxiong decoction combined with conventional western medicine and red and blue light irradiation on skin lesion severity in patients with acne. Methods A total of 62 patients with acne admitted to the Gaochun Xiaba Hospital from January 2022 to March 2025 were selected, and they were divided into the control group and the observation group by the random number table method, with 31 patients in each group. The control group was treated with conventional western medicine combined with red and blue light irradiation, and the observation group was treated with Fuling Chuanxiong decoction combined with conventional western medicine and red and blue light irradiation. The skin lesion severity, clinical efficacy, inflammatory factor levels and skin barrier function were compared between the two groups. Results The total score of skin lesions in the observation group after treatment was lower than that in the control group (P<0.05).The total effective rate of the observation group (96.77%) was higher than that of the control group (80.65%) (P <0.05).The levels of inflammatory factors in the observation group after treatment were lower than those in the control group (P <0.05). The TEWL of the observation group after treatment was lower than that of the control group, and the SCWC was higher than that of the control group (P <0.05). Conclusion Fuling Chuanxiong decoction combined with conventional western medicine and red and blue light irradiation can improve the clinical symptoms of acne patients, reduce the severity of skin lesions, inhibit inflammatory reactions, and help to restore skin barrier function.