Objective To explore the effect of red and blue light irradiation combined with fusidic acid cream on acne lesion count and facial aesthetic status in patients with moderate to severe acne. Methods A total of 100 patients with moderate to severe acne admitted to the Department of Dermatology, Qingdao Huangdao District Central Hospital from January to December 2025 were selected as the research subjects. According to the random number table method, they were divided into the control group and the observation group, with 50 patients in each group. The control group was treated with topical fusidic acid cream, and the observation group was treated with red and blue light irradiation combined with fusidic acid cream. The acne lesion count, acne severity and facial aesthetic status were compared between the two groups. Results After treatment, the number of inflammatory papules, pustules, nodules/cysts, and total lesions in the observation group was lower than that in the control group (P <0.05). After treatment, the scores for each facial region and the total GAGS score in the observation group were lower than those in the control group (P <0.05). After treatment, the scores for all indicators of facial aesthetics and the total score in the observation group were higher than those in the control group (P <0.05). Conclusion Red and blue light irradiation combined with fusidic acid cream can reduce the number of various inflammatory lesions in patients with moderate to severe acne, decrease the acne severity in multiple facial regions, and simultaneously improve indicators related to facial aesthetics.