Objective To explore the effect of intense pulsed light combined with isotretinoin on skin improvement and skin aesthetics in patients with moderate to severe acne. Methods By using the random number table method, 80 patients with moderate to severe acne admitted to Suzhou Industrial Park Point and Qingyan Medical Beauty Clinic from January to December 2024 were divided into the a control group and an observation group, 40 patients per group. The control group was treated with isotretinoin, and the observation group was treated with intense pulsed light combined with isotretinoin. The skin lesion status, symptom improvement time (pain duration, erythema duration, skin crusting time, scab detachment time) and skin aesthetics were compared between the two groups. Results Compared with the control group, the GAGS score and skin aesthetics score of the observation group at 2, 8, and 12 weeks after treatment were lower (P <0.05). Compared with the control group, the symptom improvement time of the observation group after treatment was shorter (P <0.05). Conclusion Intense pulsed light combined with isotretinoin in the treatment of patients with moderate to severe acne can improve skin lesions, shorten the pain duration, erythema duration, skin crusting time and scab detachment time, and effectively enhance skin aesthetics.