Objective To explore the effect of recombinant collagen dressing on erythema index and skin barrier function in patients with sensitive skin. Methods A total of 80 sensitive skin patients with erythema symptoms admitted to Nanjing Lishui District Hospital of Traditional Chinese Medicine from March 2025 to March 2026 were selected, and they were divided into the control group and the study group by the random number table method, with 40 patients in each group. The control group received basic moisturizing skin care guidance and normal saline wet compress, and the study group was additionally treated with topical recombinant collagen dressing on the basis of the control group. The clinical efficacy, erythema index and skin barrier function were compared between the two groups. Results The total effective rate of the study group (92.50%) was higher than that of the control group (72.50%) (P <0.05). At 2 and 4 weeks after treatment, the erythema index of the two groups was lower than that before treatment, and that of the study group was lower than that of the control group (P <0.05). At 2 and 4 weeks after treatment, the TEWL in the two groups was lower than that before treatment, and that in the study group was lower than that in the control group (P <0.05). At 2 and 4 weeks after treatment, the stratum corneum hydration in the two groups was higher than that before treatment, and that in the study group was higher than that in the control group (P <0.05). Conclusion Recombinant collagen dressing can effectively reduce the erythema index of patients with sensitive skin and improve clinical efficacy. Meanwhile, it can decrease transepidermal water loss, increase stratum corneum hydration and effectively repair skin barrier function.