[?]?Objective: To compare the efficacy of mussel adhesive protein dressing versus medical recombinant type III collagen combined with intense pulsed light (IPL) in the treatment of melasma.Methods: A total of 124 patients with melasma treated at our dermatology department from March 2024 to March 2025 were randomly assigned to control and treatment groups (n=62 each). Both groups received IPL therapy, with the control group additionally using recombinant type III collagen dressing and the treatment group using mussel adhesive protein dressing. The melasma severity, clinical efficacy, pigment improvement, immediate post-procedural symptom control, and adverse reactions were compared.Results: The total effective rate was higher in the treatment group (82.26%) than in the control group (64.52%) (P<0.05). At 28 days after the final treatment, the melanin index was lower in the treatment group (100.23±9.08 pmol/ml) than in the control group (114.07±10.94 pmol/ml) (P<0.05). At 15 min post-treatment, the treatment group showed lower erythema area percentage (5.64±0.86%) and facial temperature (34.79±3.74℃), and a greater increase in skin hydration compared to the control group (P<0.05). After the final treatment, the MASI score was lower in the treatment group (5.46±1.06 points) than in the control group (6.42±1.16 points) (P<0.05). No moderate or severe adverse reactions occurred in either group, with no statistically significant difference (P>0.05).Conclusion: The combination of mussel mucopolysaccharide and IPL therapy for melasma is superior to collagen in terms of therapeutic efficacy, immediate soothing effect, increased skin water content, reduced pigmentation, and control of post-treatment acute reactions.