Objective To analyze the effect of Omaha system theory-based continuous nursing in melasma patients treated with facial scraping technique. Methods A total of 72 melasma patients admitted to Jiangsu Province Hospital of Chinese Medicine from October 2023 to March 2026 were selected, and they were divided into the control group and the study group by the random number table method, with 36 patients in each group. The facial scraping technique was applied to both groups. The control group was given conventional nursing, and the study group was given Omaha system theory-based continuous nursing on the basis of the control group. The Melasma Area and Severity Index (MASI) score, Dermatology Life Quality Index (DLQI) score, anxiety status and nursing satisfaction were compared between the two groups. Results After nursing, the MASI score of the study group was lower than that of the control group (P <0.05). After nursing, the DLQI score of the study group was lower than that of the control group (P <0.05). After nursing, the SAS score of the study group was lower than that of the control group (P <0.05). The nursing satisfaction rate of the study group (91.67%) was higher than that of the control group (72.22%) (P <0.05). Conclusion Omaha system theory-based continuous nursing has definite efficacy in melasma patients treated with facial scraping technique. It can promote the regression of melasma lesions, improve patients' quality of life, relieve anxiety, and increase nursing satisfaction.