Objective To observe the effect and safety of self-made Shugan Jianpi Bushen Huoxue decoction combined with chloasma dressing in the treatment of chloasma. Methods A total of 70 patients with chloasma admitted to our hospital from March 2023 to March 2024 were selected as the research objects and divided into control group and observation group by random number table method, with 35 patients in each group. The control group was treated with conventional western medicine, and the observation group was treated with self-made Shugan Jianpi Bushen Huoxue decoction combined with chloasma dressing. The clinical efficacy, adverse reactions, TCM syndrome scores and skin lesion recovery were compared between the two groups. Results The total effective rate of treatment in the observation group was 97.14%, which was higher than 82.86% in the control group (P <0.05). The incidence of adverse reactions in the observation group was 5.71%, which was lower than 22.86% in the control group (P <0.05). After treatment, the scores of irritability, chest pain and facial macular in the observation group were lower than those in the control group (P <0.05). After treatment, the MASI score of the observation group was lower than that of the control group (P <0.05). Conclusion Self-made Shugan Jianpi Bushen Huoxue decoction combined with chloasma dressing is effective in the treatment of chloasma, with fewer adverse reactions and high safety. Meanwhile, it can effectively improve the symptoms of chloasma and promote the recovery of skin lesions.