Objective To analyze the effect of Huoxue Huayu decoction combined with laser treatment on skin condition and antioxidant capacity in patients with melasma. Methods A total of 42 patients with melasma admitted to Putuo District Shiquan Street Community Health Service Center from February 2022 to February 2024 were selected as the research subjects. According to the random number table method, they were divided into the control group and the study group, with 21 patients in each group. The control group received laser treatment, and the study group received Huoxue Huayu decoction combined with laser treatment. The skin condition, antioxidant capacity, treatment effect and sex hormone levels were compared between the two groups. Results After treatment, the skin Melanin Index (MI) and Erythema Index (EI) in the two groups were lower than those before treatment, and those in the study group were lower than those in the control group (P <0.05). After treatment, the level of malondialdehyde (MDA) in the two groups was lower than that before treatment, and the levels of catalase (CAT) and superoxide dismutase (SOD) were higher than those before treatment (P <0.05), but there were no significant differences between the two groups after treatment (P >0.05). The total effective rate of treatment in the study group was 100.00%, which was higher than 76.19% in the control group (P <0.05). After treatment, the levels of serum estradiol (E2), luteinizing hormone (LH) and follicle-stimulating hormone (FSH) in the two groups were lower than those before treatment, and those in the study group were lower than those in the control group (P <0.05).Conclusion The application of Huoxue Huayu decoction combined with laser treatment for patients with melasma has a good effect. It can effectively improve the skin condition of patients, enhance their antioxidant capacity, help to increase the total effective rate of treatment, and regulate the levels of sex hormones, which is worthy of clinical application.