Objective To explore the effect of refined nursing in the treatment of severe acne with aminolevulinic acid (ALA) photodynamic therapy. Methods A total of 60 patients with moderate to severe acne who received ALA photodynamic therapy in our hospital from January 2021 to December 2022 were selected as the study subjects. They were divided into two groups according to the random number table method, with 30 patients in each group. The control group was given routine nursing, and the experimental group was given refined nursing. The quality of life, bad mood, nursing satisfaction and adverse reactions were compared between the two groups. Results The incidence of adverse reactions in the experimental group was 3.33%, which was lower than 6.67% in the control group, but the difference was not statistically significant (P>0.05). The scores of depression and anxiety in the experimental group were lower than those in the control group (P<0.05). The quality of life score of the experimental group was higher than that of the control group (P<0.05). The satisfaction of the experimental group was 93.33%, which was higher than 73.33% of the control group (P<0.05). Conclusion The use of refined nursing in ALA photodynamic therapy for moderate to severe acne can help improve patients' bad mood, improve quality of life and nursing satisfaction, which is worthy of clinical application.