Objective To explore the effect of Q-switched (QS) 532 nm laser and QS-755 nm laser on quality of life and recurrence rate in patients with café-au-lait macule. Methods A total of 343 patients with café-au-lait macule admitted to the Dermatology Department of Xuzhou Central Hospital from January 2017 to January 2024 were selected as the research subjects, and they were divided into the control group (n =126) and the observation group (n =217) according to different treatment methods. The control group was treated with Q-switched 532 nm (QS-532 nm) laser, and the observation group was treated with Q-switched 755 nm (QS-755 nm) laser. The clinical efficacy, quality of life, recurrence rate and adverse reaction rate were compared between the two groups. Results The total effective rate of treatment in the observation group (81.57%) was higher than that in the control group (65.08%) (P <0.05). The quality of life score in the observation group after treatment was lower than that in the control group (P <0.05). The recurrence rate in the observation group (7.37%) was lower than that in the control group (14.29%) (P <0.05). The incidence of adverse reactions in the observation group (11.06%) was lower than that in the control group (19.84%) (P <0.05). All patients who received treatment showed no scar formation. Conclusion Compared with QS-532 nm laser, QS-755 nm laser has better clinical effect in the treatment of patients with café-au-lait macule, which can effectively reduce the adverse reaction rate and recurrence rate, thereby improving the quality of life, and is worthy of clinical application.