Objective To explore the effect of bepotastine besilate tablets combined with compound glycyrrhizin tablets on skin barrier repair and aesthetics in patients with eczema. Methods A total of 90 patients with eczema admitted to Baise Dermatology Prevention and Treatment Hospital from October 2023 to July 2025 were selected, and they were divided into the control group (45 patients) and the observation group (45 patients) by the random number table method. The control group was treated with oral bepotastine besilate tablets, and the observation group was additionally treated with compound glycyrrhizin tablets on the basis of the control group. The lesion severity, skin barrier function, aesthetics, immune and inffammatory indicators were compared between the two groups. Results After treatment, the EASI score of the observation group [(5.22±1.84)points] was lower than that of the control group [(8.93±2.40)points] (P<0.05). After treatment, the TEWL in the observation group was lower than that in the control group, and the stratum corneum hydration was higher than that in the control group (P<0.05). After treatment, the MI, EI and the serum levels of total IgE and EOS in the observation group were lower than those in the control group (P<0.05). Conclusion The combination of bepotastine besilate tablets and compound glycyrrhizin tablets can effectively repair skin lesions and skin barrier function of patients with eczema, relieve inffammatory and immune responses, and improve the aesthetics.