Objective To analyze the effect of progressive health education combined with specialist nursing on cognition and self-care ability of patients with hypertrophic scar during drug combined with CO2 fractional laser therapy. Methods A total of 100 patients with hypertrophic scar admitted to our hospital from January 2022 to January 2025 were selected as the research subjects, and they were divided into the control group and the observation group by the random drawing method, with 50 patients in each group. Both groups were treated with drug and CO2 fractional laser. The control group received conventional nursing, and the observation group received progressive health education combined with specialist nursing. The cognition, self-care ability, coping style and adverse reaction rate were compared between the two groups. Results The cognition rate of the observation group (98.00%) was higher than that of the control group (80.00%) (P <0.05). After nursing, the scores of self-concept, health cognition, self-care responsibility and self-care skills in the observation group were higher than those in the control group (P <0.05). After nursing, the score of confrontation in the observation group was higher than that in the control group, and the scores of submission and avoidance were lower than those in the control group (P <0.05). The incidence of adverse reactions in the observation group was slightly lower than that in the control group, but the difference was not statistically significant (P >0.05). Conclusion During combined drug and fractional CO2 laser therapy for hypertrophic scar patients, the application of progressive health education combined with specialist nursing can improve their cognition rate, positive coping style and self-care ability, which has clinical application value.