Objective To explore the clinical effect of Er:YAG fractional laser in the treatment of rosacea and its effect on skin condition. Methods A total of 94 patients who were admitted in Tianjin Hexi Weimei Aesthetic Medicine Hospital from November 2021 to June 2022 were selected, and divided into the study group (47 patients) and the control group (47 patients) by random number table method. The control group was given intensive pulsed light, and the study group was given Er:YAG fractional laser. The clinical efficacy, skin condition, and adverse reactions of the two groups were compared. Results The total effective rate of treatment in the study group (97.87%) was higher than that in the control group (82.98%), and the difference was statistically significant (P<0.05). After treatment, the scores of pruritus, erythema and papule pustules in the two groups were lower than those before treatment, and those in the study group were lower than those in the control group, the differences were statistically significant (P<0.05). The incidence of adverse reactions in the study group (4.26%) was lower than that in the control group (19.15%), the difference was statistically significant (P<0.05). Conclusion Er:YAG fractional laser treatment can improve the clinical efficacy of patients with rosacea, improve their skin condition and reduce the incidence of adverse reactions.