Objective To analyze the effect of isotretinoin combined with fractional laser technology on wound healing and skin physiological state in patients with mild to moderate acne vulgaris. Methods A total of 120 patients with mild to moderate acne vulgaris admitted to Cengong County People's Hospital from June 2024 to March 2025 were selected as the research subjects, and they were divided into the control group and the observation group by the random number table method, with 60 patients in each group. The control group was treated with fractional laser technology, and the observation group was treated with isotretinoin combined with fractional laser technology. The wound healing, skin physiological state and adverse reaction rate were compared between the two groups. Results The incrustation time, decrustation time and wound healing time of the observation group were shorter than those of the control group (P<0.05). After treatment, the scores of red area, porphyrin, pores, spots and texture in the observation group were lower than those in the control group (P<0.05). The incidence of adverse reactions in the observation group (3.33%) was lower than that in the control group (18.33%) (P<0.05). Conclusion The combined application of isotretinoin and fractional laser shows a good synergistic effect in the treatment of mild to moderate acne vulgaris. It not only helps to accelerate the process of skin lesion repair, but also effectively improves the overall skin state, while reducing the risk of adverse reactions.