To explore the clinical effect and safety of 48% new compound acid combined with hyaluronic acid repair dressing in the treatment of pigmentation after acne inflammation. Methods From February to August 2023, 50 patients with pigmentation after acne inflammation were randomly divided into control group and experimental group, with 25 patients in each group. The control group was treated with 30% salicylic acid combined with hyaluronic acid repair dressing, and the experimental group was treated with 48% new compound acid combined with hyaluronic acid repair dressing. The visual effect score, clinical efficacy, skin physiological indexes and adverse reactions were compared between the two groups. Results The visual effect score of the experimental group was lower than that of the control group (P <0.05). The total effective rate of treatment in the experimental group was 96.00%, which was higher than 84.00% in the control group (P <0.05). After treatment, the percutaneous water loss and epidermal sebum content in the experimental group were lower than those in the control group, and the water content in the s tratum corneum was higher than that in the control group (P <0.05). The incidence of adverse reactions in the experimental group was 4.00%, which was lower than 20.00% in the control group (P <0.05). Conclusion The effect of 48% new compound acid combined with hyaluronic acid repair dressing in the treatment of pigmentation after acne inflammation is good, which can effectively alleviate the clinical symptoms of patients, improve the visual effect, improve the skin physiological indexes, and h as good safety.