Objective To investigate the effect of supramolecular salicylic acid combined with intense pulsed light on lesion count and symptom improvement time in patients with moderate to severe acne. Methods A total of 100 patients with moderate to severe acne admitted to Luohe Second People's Hospital from January 2023 to October 2024 were selected and divided into control group and the study group by the random number table method, with 50 patients in each group. The control group received supramolecular salicylic acid treatment, and the study group received supramolecular salicylic acid combined with intense pulsed light treatment. The lesion count, symptom improvement time, treatment effect and severity of acne and erythema were compared between the two groups. Results The number of comedones, inflammatory papules, pustules, cysts and nodules in the study group was fewer than that in the control group (P <0.05). The descrustation time, incrustation time, erythema duration and pain duration in the study group were shorter than those in the control group (P <0.05). The total effective rate of treatment in the study group (96.00%) was higher than that in the control group (82.00%) (P <0.05). After treatment,the scores of TRASS and CEA in the study group were lower than those in the control group (P <0.05). Conclusion The application of supramolecular salicylic acid combined with intense pulsed light in patients with moderate to severe acne has a good effect, which can effectively reduce the number of lesions, shorten the symptom improvement time, improve the severity of acne and erythema, accelerate symptom improvement, and promote recovery.