Objective To analyze the effect of adapalene gel on facial skin aesthetic improvement in patients with mild to moderate acne. Methods A total of 102 patients with mild to moderate acne admitted to Suining Central Hospital from January to December 2025 were selected, and they were divided into the control group and the experimental group by the random number table method, with 51 patients in each group. The control group received routine basic treatment, and the experimental group received adapalene gel treatment on the basis of the control group. The clinical efffcacy, facial skin aesthetic improvement and adverse reactions were compared between the two groups. Results The total effective rate of the experimental group (92.16%) was higher than that of the control group (74.51%) (P<0.05). The skin aesthetic scores of the experimental group at 4 and 8 weeks after treatment were higher than those of the control group (P<0.05). The incidence of adverse reactions in the experimental group (37.25%) was higher than that in the control group (11.76%) (P<0.05). Conclusion Adapalene gel has a good effect in the treatment of mild to moderate acne, which can effectively promote facial skin aesthetic improvement and reduce skin lesions. Although the risk of adverse reactions such as erythema, dryness and desquamation is relatively high, most of them are mild and controllable, with deffnite application value.