Objective To explore the effect of delicate pulse light combined with botulinum toxin injection in the treatment of patients with rosacea. Methods A total of 120 patients with rosacea admitted to our hospital from September 2021 to August 2023 were selected as the research objects. They were divided into control group and observation group by random number table method, with 60 patients in each group. The control group was treated with delicate pulse light, and the observation group was treated with delicate pulse light combined with botulinum toxin injection. The clinical efficacy, skin barrier function, skin physiological indexes, aesthetics and adverse reactions were compared between the two groups. Results The scores of CEA and PGA in the observation group were lower than those in the control group (P<0.05). After intervention, the transcutaneous water loss in the observation group was lower than that in the control group, and the epidermal water content was higher than that in the control group (P<0.05). The melanin index and erythema index in the observation group were lower than those in the control group after intervention (P <0.05). The aesthetic degree of the observation group was 96.67%, which was higher than 83.33% of the control group (P<0.05). The incidence of adverse reactions in the observation group was 3.33%, which was lower than 8.33% in the control group, but the difference was not statistically significant (P>0.05). Conclusion The effect of delicate pulse light combined with botulinum toxin injection in patients with rosacea is definite, which can improve the skin barrier function and improve the aesthetics of patients. It is worthy of clinical application.