Objective To explore the application e?ect of skin barrier repair combined with retinoic acid drugs in the treatment of severe acne. Methods A total of 50 patients with severe acne admitted to Sengong Hospital of Shaanxi Province from March 2022 to March 2023 were selected as the research objects. According to the random number table method, they were divided into control group and observation group, with 25 patients in each group. The control group was treated with retinoic acid drugs, and the observation group was treated with skin barrier repair combined with retinoic acid drugs. The clinical efcacy, adverse reaction and psychological status of the two groups were compared. Results The total e?ective rate of the observation group was higher than that of the control group after 2 weeks, 4 weeks and 6 weeks of treatment, and the di?erence was statistically signifcant (P<0.05). The incidence of adverse reactions in the observation group was 4.00%, which was lower than 28.00% in the control group, and the di?erence was statistically signifcant (P<0.05). After treatment, the SAS and SDS scores of the observation group were lower than those of the control group, and the di?erences were statistically signifcant (P<0.05). Conclusion Skin barrier repair combined with retinoic acid drugs is e?ective in patients with severe acne, which can e?ectively improve the clinical treatment e?ect, reduce the incidence of adverse reactions, and improve the negative emotions of patients.