Objective To explore the effect of hydroquinone cream combined with hyaluronic acid repair dressing on pigmentation severity in patients with facial pigmentation. Methods A total of 60 patients with facial pigmentation admitted to Suining Central Hospital from March 2024 to March 2025 were selected as the research subjects, and they were divided into group A and group B by the random number table method, with 30 patients in each group. Group A was treated with hydroquinone cream, and group B was treated with hyaluronic acid repair dressing on the basis of group A. The pigmentation severity, clinical efffcacy, skin barrier function and adverse reaction rate were compared between the two groups. Results The MASI score of group B after treatment was lower than that of group A (P<0.05). The total effective rate of group B (83.33%) was higher than that of group A (60.00%) (P<0.05). After treatment, the transepidermal water loss of group B was lower than that of group A, and the stratum corneum water content was higher than that of group A (P<0.05). The incidence of adverse reactions in group B (13.33%) was lower than that in group A (40.00%) (P<0.05). Conclusion For patients with facial pigmentation, combined therapy of hydroquinone cream and hyaluronic acid repair dressing can elevate therapeutic efffciency, relieve pigmentation and improve skin barrier function, as well as reduce the risk of adverse reactions, with favorable safety.