Objective To investigate the effect of Q-switched 1064 nm Nd:YAG laser combined with alpha hydroxy acid on skin lesions in patients with chloasma. Methods A total of 160 patients with chloasma admitted to Nanjing Medi Gentle Medical Beauty Clinic from January to June 2024 were selected as the research subjects. According to different treatment schemes, they were divided into control group and study group, with 80 patients in each group. The control group was treated with alpha hydroxy acid, and the study group was treated with Q-switched 1064 nm Nd:YAG laser combined with alpha hydroxy acid. The skin lesions, treatment effect, quality of life, treatment satisfaction and adverse reactions were compared between the two groups. Results After treatment, the skin lesion area, skin lesion color score and total score in the study group were lower than those in the control group (P <0.05). The total effective rate of treatment in the study group was 93.75%, which was higher than 75.00% in the control group (P <0.05). The scores of emotion, interpersonal communication and self-evaluation in the study group were lower than those in the control group (P <0.05). The treatment satisfaction score in the study group was higher than that in the control group (P <0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P >0.05). Conclusion The application of Q-switched 1064 nm Nd:YAG laser combined with alpha hydroxy acid in patients with chloasma can effectively improve the skin lesions, reduce pigmentation, improve the treatment effect and satisfaction, and will not increase the incidence of adverse reactions. The application is safe and has positive significance for improving the quality of life of patients.