Objective To analyze the effect of mussel adhesive protein repair dressing combined with intense pulsed light on pigment improvement in patients with melasma. Methods A total of 100 patients with melasma who were treated in our hospital from December 2023 to December 2024 were selected as the research subjects. According to the random number table method, they were divided into the control group and the experimental group, with 50 patients in each group. The control group was treated with medical recombinant type Ⅲ humanized collagen dressing combined with intense pulsed light, and the experimental group was treated with mussel adhesive protein repair dressing combined with intense pulsed light. The clinical efficacy, pigment improvement, Visual Analogue Scale (VAS) and anxiety level were compared between the two groups. Results The total effective rate of treatment in the experimental group (94.00%) was higher than that in the control group (84.00%) (P<0.05). The melanin index of the experimental group at 4 weeks after treatment was lower than that of the control group (P<0.05). The incidence of PIH in the experimental group (22.00%) was lower than that in the control group (36.00%) (P<0.05). The scores of erythema in the experimental group at 24 h and 72 h after treatment were lower than those in the control group, and the scores of edema and pain in the experimental group at 72 h after treatment were lower than those in the control group (P<0.05). The HAMD score of the experimental group after treatment was lower than that of the control group (P<0.05). Conclusion The clinical effect of mussel adhesive protein repair dressing combined with intense pulsed light in the treatment of melasma is good, which can effectively reduce pigmentation and improve the clinical symptoms of patients, thereby reducing their anxiety level. It is worthy of clinical application.