Objective To explore the effect of mussel adhesive protein repair dressing combined with intense pulsed light (IPL) on skin melanin index in patients with melasma. Methods A total of 124 patients with melasma who visited the Dermatology Outpatient Department of our hospital from March 2024 to March 2025 were selected, and they were divided into the control group and the study group by the random number table method, with 62 patients in each group. The control group was treated with IPL combined with medical recombinant type Ⅲ collagen repair patch, and the study group was treated with IPL combined with mussel adhesive protein repair dressing. The skin melanin index, melasma severity, clinical efficacy, immediate postoperative symptom control indicators and adverse reactions were compared between the two groups. Results The MI of the study group at 28 days after the last treatment was lower than that of the control group (P<0.05). The MASI scores of the study group at 4 weeks, 8 weeks after treatment and 28 days after the last treatment were lower than those of the control group (P<0.05). The total effective rate of the study group was 82.26%, which was higher than 64.52% of the control group (P<0.05). The proportion of red area, heat degree and skin moisture content in the study group at T1 were better than those in the control group (P<0.05). There was no statistically signiffcant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusion Mussel adhesive protein repair dressing combined with IPL in the treatment of melasma can immediately relieve related symptoms, effectively improve clinical efficacy, control acute postoperative reactions, increase skin moisture content, reduce pigmentation, and does not increase the incidence of adverse reactions.