Objective To analyze the effect of facial refined nursing on acne severity and facial skin physiological indicators in patients with acne vulgaris. Methods A total of 100 patients with acne vulgaris admitted to the 960th Hospital of the People's Liberation Army from January 2024 to January 2025 were selected, and they were divided into the reference group and the observation group by the random number table method, with 50 patients in each group. The reference group received traditional facial nursing, and the observation group received facial refined nursing. The acne severity, facial skin physiological indicators, adverse reaction rate and recurrence rate were compared between the two groups. Results After nursing, the score of GAGS in the two groups was lower than that before nursing, and that in the observation group was lower than that in the reference group (P<0.05). The skin moisture content of the two groups after nursing was higher than that before nursing, and the skin lesion score and seborrhea score were lower than those before nursing. The skin moisture content of the observation group after nursing was higher than that of the reference group, and the skin lesion score and seborrhea score were lower than those of the reference group (P<0.05). The incidence of adverse reactions and recurrence rate in the observation group were lower than those in the reference group (P<0.05). Conclusion The application of facial refined nursing in patients with acne vulgaris can not only effectively reduce the severity of acne and improve facial skin physiological indicators, but also reduce the incidence of adverse reactions and recurrence rate, which has definite clinical application value.