Objective To explore the effect of intense pulsed light combined with supermolecular salicylic acid on skin lesion severity in patients with rosacea. Methods A total of 80 patients with rosacea admitted to the Dermatology Clinic of Weifang Tayhoo Medical Aesthetic Hospital from January 2024 to March 2025 were selected. According to the random number table method, they were divided into the control group and the treatment group, with 40 patients in each group. The control group was treated with intense pulsed light alone, and the treatment group was treated with intense pulsed light combined with supermolecular salicylic acid. The skin lesion severity, skin barrier function, clinical efffcacy and adverse reaction rate were compared between the two groups. Results After treatment, the scores of all skin lesion severity indicators in the treatment group were lower than those in the control group (P<0.05). At 1 month after treatment and 1 month after the end of treatment, the TEWL in the treatment group was lower than that in the control group, and the stratum corneum hydration was higher than that in the control group (P<0.05). The total effective rate of the treatment group (97.50%) was higher than that of the control group (67.50%) (P<0.05). The incidence of adverse reactions in the treatment group (25.00%) was lower than that in the control group (52.50%) (P<0.05). Conclusion Intense pulsed light combined with supermolecular salicylic acid in the treatment of rosacea can improve clinical efffcacy, effectively reduce the severity of skin lesions, help to improve skin barrier function, and has favorable safety.