To explore the effect of compound glycyrrhizin combined with azelastine on skin aesthetics in elderly patients with chronic eczema. Methods A total of 60 elderly patients with chronic eczema admitted to our hospital from February to June 2023 were selected as the research objects. They were divided into control group and observation group according to different treatment methods, with 30 patients in each group. Both groups were given basic intervention measures. The control group was treated with azelastine. The observation group was treated with compound glycyrrhizin combined with azelastine. The clinical efficacy, rash, nodules, wheals, blisters, scratches, pruritus degree, skin aesthetics and adverse reactions were compared between the two groups. Results The total effective rate of treatment in the observation group was 97.06%, which was higher than 76.47% in the control group (P <0.05). The number of pruritus, rashes, nodules, wheals, blisters and scratches in the observation group was less than that in the control group (P <0.05). After treatment, the FIIQ score and VSS score of the two groups were lower than those before treatment, and the observation group was lower than the control group (P <0.05). The incidence of adverse reactions in the observation group was 13.33%, which was lower than 40.00% in the control group (P <0.05). Conclusion Compound glycyrrhizin combined with azelastine has a good effect in the treatment of chronic eczema in the elderly, which can effectively reduce the number of skin rashes, nodules, wheals, blisters and scratches, relieve pruritus symptoms, improve skin aesthetics and reduce the incidence of complications. It is worthy of clinical application.