Objective To explore the effect of personalized skin nursing combined with health education on disease cognition and skin condition in patients with severe acne. Methods A total of 120 patients with severe acne admitted to the Department of Medical Cosmetology, Wuzhong District Chengnan Street Community Health Service Center from January 2024 to January 2025 were selected as the research subjects, and they were divided into the control group and the observation group according to the order of admission, with 60 patients in each group. The control group received conventional nursing, and the observation group received personalized skin nursing combined with health education. The disease cognition, skin condition, psychological status and quality of life were compared between the two groups. Results The scores of disease cognition in the observation group after nursing were higher than those in the control group (P <0.05). The scores of redness, pain, cysts and pustules in the observation group after nursing were lower than those in the control group (P <0.05). The psychological status scores of the observation group after nursing were lower than those of the control group (P <0.05). The quality of life scores of the observation group after nursing were higher than those of the control group (P <0.05). Conclusion The combination of personalized skin nursing and health education can effectively improve the disease cognition level of patients with severe acne, improve skin condition, alleviate emotions such as anxiety and depression, and comprehensively enhance the quality of life.