Objective To compare the effect of intensive pulsed light and liquid nitrogen cryotherapy in patients with freckles. Methods A total of 160 patients with freckles admitted to the Cosmetic Dermatology Department of Xi'an Jiaotang Medical and Aesthetic Hospital from March 2021 to March 2022 were randomly divided into control group and observation group, with 80 patients in each group. The control group was treated with liquid nitrogen freezing, and the observation group was treated with intensive pulsed light. The skin lesions, clinical efficacy, recurrence and temporary pigmentation were compared between the two groups. Results The skin lesion area, skin lesion color score and total score of the two groups after treatment were lower than those before treatment (P <0.05), however, there was no significant difference in skin lesion area, skin lesion color score and total score between the two groups after treatment (P >0.05). There was no significant difference in the total effective rate between the two groups (P >0.05). The recurrence rate of the observation group was lower than that of the control group, and the average recurrence time was longer than that of the control group (P <0.05). There was no significant difference in the severity of recurrence between the two groups (P >0.05). There was no significant difference in the incidence of temporary pigmentation between the two groups (P >0.05). Conclusion The efficacy of intensive pulsed light and liquid nitrogen freezing in the treatment of freckles and the improvement of skin lesions are comparable. The incidence of temporary pigmentation after treatment is low, but the therapeutic effect of intensive pulsed light is more lasting and has a definite advantage in delaying recurrence.