Objective To analyze the effect of cognitive reconstruction psychological nursing combined with detailed intervention on skin lesions in chloasma patients treated with nanocrystalline introduction of tranexamic acid. Methods From July 2022 to December 2023, 80 chloasma patients who underwent nanocrystalline introduction of tranexamic acid at Jiangning District CDC Dermatology Institute were selected as the research subjects, and they were divided into control group and observation group by the random number table method, with 40 patients in each group. The control group was given routine nursing, and the observation group was given cognitive reconstruction psychological nursing combined with detailed intervention. The skin lesions, intervention effect, quality of life, adverse emotions and nursing satisfaction were compared between the two groups. Results The MASI score of the observation group after nursing was lower than that of the control group (P <0.05). The total effective rate of the observation group was 92.50%, which was higher than 80.00% of the control group (P <0.05). The scores of all dimensions of the quality of life and the total score in the observation group after nursing were higher than those in the control group (P <0.05). The scores of SAS and SDS in the observation group after nursing were lower than those in the control group (P <0.05). The satisfaction of nursing in the observation group was 67.50%, which was higher than 47.50% in the control group (P <0.05). Conclusion The application of cognitive reconstruction psychological nursing combined with detailed intervention in chloasma patients treated with nanocrystalline introduction of tranexamic acid is effective, which can effectively improve patients’ skin lesions, reduce adverse emotions, and have positive significance in improving quality of life and nursing satisfaction.