Objective To explore the efficacy and safety of intense pulsed light combined with ablative fractional laser in the treatment of patients with severe acne scar. Methods A total of 80 patients with severe acne scar admitted to Funing County Traditional Chinese Medicine Hospital from January 2022 to August 2024 were selected as the research subjects. According to different treatment methods, they were divided into the control group (n =40) and the study group (n =40). The control group received ablative fractional laser treatment, and the study group received intense pulsed light combined with ablative fractional laser. The symptom improvement, skin barrier function, quality of life and adverse reactions were compared between the two groups. Results After intervention, the scores of erythema, pigmentation and scar in the study group were lower than those in the control group, and the differences were statistically significant (P <0.05). After intervention, the skin moisture content in the study group was higher than that in the control group, and the transepidermal water loss in the study group was lower than that in the control group, and the differences were statistically significant (P<0.05). After intervention, the quality of life score in the study group was lower than that in the control group, and the difference was statistically significant (P<0.05). The incidence of adverse reactions in the study group (5.00%) was lower than that in the control group (10.00%), but the difference was not statistically significant (P >0.05). Conclusion Intense pulsed light combined with ablative fractional laser can effectively improve the clinical symptoms and skin barrier function of patients with severe acne scar, and is beneficial to improving their quality of life, with higher application safety.