Objective To explore the effect of botulinum toxin combined with intense pulsed light treatment on symptom outcome and skin barrier function in patients with refractory erythema of rosacea. Methods A total of 74 patients with refractory erythema of rosacea admitted to 7HE Vlines Medical Beauty Meixihu Clinic from June 2022 to June 2024 were selected as the research subjects. According to the random number table method, they were divided into the control group and the observation group, with 37 patients in each group. The control group was treated with intense pulsed light, and the observation group was treated with botulinum toxin combined with intense pulsed light. The symptom outcome, skin barrier function, clinical efficacy and adverse reactions were compared between the two groups. Results After treatment, the scores of erythema and the Clinician Erythema Assessment scale (CEA) in the observation group were both better than those in the control group (P <0.05). After treatment, the stratum corneum hydration in the observation group was higher than that in the control group, and the transepidermal water loss was lower than that in the control group (P <0.05). The total effective rate of treatment in the observation group (97.30%) was higher than that in the control group (81.08%) (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 botulinum toxin combined with intense pulsed light treatment for patients with refractory erythema of rosacea is highly effective, which can effectively improve the clinical symptoms and skin condition, enhance the skin barrier function, and does not increase the incidence of adverse reactions. It has high safety and is worthy of clinical application.