Objective To investigate the effect of Shugan Jianpi Huaban decoction combined with tretinoin cream on skin lesions in female chloasma patients with liver stagnation and spleen deficiency type. Methods A total of 32 female chloasma patients with liver stagnation and spleen deficiency type admitted to our hospital from March 2021 to January 2024 were selected as the research subjects, and they were divided into control group and study group according to the random number table method, with 16 patients in each group. The control group was treated with tretinoin cream, and the study group was treated with Shugan Jianpi Huaban decoction combined with tretinoin cream. The skin lesions, treatment effect, TCM symptom scores and adverse reactions were compared between the two groups. Results The MSAI score in the study group after treatment was lower than that in the control group (P <0.05). The total effective rate of treatment in the study group was 100.00%, which was higher than 75.00% in the control group (P <0.05). The scores of all TCM symptoms in the study group after treatment were lower than those in the control group (P <0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups (P >0.05). Conclusion The administration of Shugan Jianpi Huaban decoction combined with tretinoin cream in female chloasma patients with liver stagnation and spleen deficiency type can effectively improve the skin lesions and alleviate the TCM symptoms, which is conducive to improving the total effective rate of treatment, and does not increase the incidence of adverse reactions, with higher treatment efficacy and safety.