Objective To explore the effect of fusidic acid combined with chemical peeling on skin lesion symptoms in patients with acne vulgaris. Methods A total of 64 patients with acne vulgaris admitted to Beijing Mentougou District Hospital from August 2024 to August 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 32 patients in each group. The control group was treated with fusidic acid, and the observation group was treated with fusidic acid combined with chemical peeling. The skin lesion symptoms, clinical efffcacy, skin lesion improvement, recurrence and adverse reaction rate were compared between the two groups. Results The skin lesion symptom score of the observation group after treatment was lower than that of the control group (P<0.05). The total effective rate of the observation group (96.88%) was higher than that of the control group (75.00%) (P<0.05). The total number of skin lesions, the number of inffammatory lesions, and the number of non-inffammatory lesions in the observation group after treatment were all fewer than those in the control group (P<0.05). The recurrence rate of the observation group was 6.25%, which was lower than 28.13% of the control group (P<0.05). There was no statistically signiffcant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion Fusidic acid combined with chemical peeling has a good curative effect in the treatment of acne vulgaris, which can effectively improve skin lesions, relieve clinical symptoms, reduce the recurrence rate of the disease, and has good safety and effectiveness.