Objective To investigate the clinical effect of red and blue light combined with traditional Chinese medicine gesso pourmask in the treatment of acne vulgaris. Methods A total of 46 patients with acne vulgaris admitted to the Department of Dermatology, No.988 Hospital of Joint Logistic Support Force of PLA from November 2022 to August 2024 were selected as the research subjects, and they were divided into experimental group and reference group by different treatment schemes, with 23 patients in each group. The reference group was treated with red and blue light, and the experimental group was treated with traditional Chinese medicine gesso pourmask on the basis of red and blue light. The clinical efficacy, facial skin barrier parameters, symptom improvement time and adverse reactions were compared between the two groups. Results The total effective rate of treatment in the experimental group was 95.65%, which was higher than 73.91% in the reference group (P <0.05). After treatment, the stratum corneum hydration, sebum secretion and pH value in the experimental group were better than those in the reference group (P <0.05). The duration of pain, crustation, decrustation and complete healing time in the experimental group were all shorter than those in the reference group (P <0.05). The incidence of adverse reactions in the experimental group was lower than that in the reference group (P <0.05). Conclusion The application of traditional Chinese medicine gesso pourmask combined with red and blue light irradiation in the treatment of acne vulgaris can improve the clinical efficacy, facilitate the facial skin barrier parameters, accelerate the healing speed of acne, and it has certain safety.