Objective To investigate the effect of red and blue light and acne extrusion combined with glycolic acid peel on skin improvement in patients with moderate to severe acne. Methods A total of 100 patients with moderate to severe acne admitted to Zhangjiagang First People's Hospital from June 2021 to December 2023 were selected as the research subjects. According to different treatment methods, they were divided into the control group (n =50) and the study group (n =50).The control group was treated with acne extrusion combined with glycolic acid peel, and the study group was treated with red and blue light and acne extrusion combined with glycolic acid peel. The skin improvement, treatment effect, adverse reactions and quality of life were compared between the two groups. Results After treatment, the scores of forehead, nose, mandible, right cheek and left cheek in the study group were better than those in the control group (P <0.05). The total effective rate of treatment in the study group (100.00%) was higher than that in the control group (88.00%) (P <0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P >0.05). The quality of life score in the study group after treatment was lower than that in the control group (P <0.05). Conclusion Red and blue light and acne extrusion combined with glycolic acid peel can effectively improve the skin improvement of patients with moderate to severe acne. The treatment effect is ideal, which is conducive to improving the quality of life of patients, and will not increase the risk of adverse reactions. The application safety is high.