Objective To explore the effect of nursing intervention based on IKAP theory on skin quality in patients with severe acne. Methods A total of 66 patients with severe acne admitted to our hospital from October 2022 to March 2025 were selected, and they were divided into the reference group and the observation group by the random number table method, with 33 patients in each group. The reference group received basic nursing intervention, and the observation group received nursing intervention based on IKAP theory. The skin quality, symptoms score, self-efficacy, quality of life and intervention satisfaction were compared between the two groups. Results After intervention, the transepidermal water loss and heme content of the observation group were better than those of the reference group (P <0.05). After intervention, the scores of erythema and pigmentation in the observation group were lower than those in the reference group (P <0.05). After intervention, the self-efficacy score of the observation group was higher than that of the reference group (P <0.05). After intervention, the score of quality of life in the observation group was higher than that in the reference group (P <0.05). The intervention satisfaction rate of the observation group was 96.97%, which was higher than 78.79% of the reference group (P <0.05). Conclusion The application of nursing intervention based on IKAP theory in patients with severe acne has a good effect. It can further optimize skin quality, reduce clinical symptoms, help to improve patients' self-efficacy and quality of life, and play a positive role in enhancing their satisfaction.