Objective To analyze the efffcacy of 5-aminolevulinic acid (ALA) photodynamic therapy combined with topical medications in the treatment of facial ffat warts. Methods A total of 300 patients with facial ffat warts treated in our hospital from January 2024 to June 2025 were selected, and they were divided into the basic group and the study group by the random number table method, with 150 patients in each group. The basic group was treated with recombinant human interferon α-2b gel combined with adapalene gel, and the study group received ALA photodynamic therapy on the basis of the basic group. The treatment effect, skin barrier function, adverse reactions and cosmetic satisfaction were compared between the two groups. Results The total effective rate of treatment in the study group (94.00%) was higher than that in the basic group (82.00%) (P<0.05). After intervention, the TEWL and stratum corneum hydration in the study group were better than those in the basic group (P<0.05). There was no statistically signiffcant difference in the incidence of adverse reactions between the two groups (P>0.05). The scores of skin smoothness, pigment uniformity, scar formation, overall aesthetics and total score in the study group were higher than those in the basic group (P<0.05). Conclusion ALA photodynamic therapy combined with topical medications in the treatment of facial ffat warts can enhance the treatment effect, improve the facial barrier function and cosmetic satisfaction, with good safety.