Objective To analyze the clinical efficacy of facial chemical peeling combined with microneedle therapy in patients with refractory acne. Methods A total of 80 patients with refractory acne admitted to the Department of Dermatology, Xi’an 630 Hospital from February to December 2025 were selected as the research subjects, and they were divided into the control group and the study group by the random number table method, with 40 patients in each group. The control group received conventional intervention, and the study group received combined intervention of facial chemical peeling and microneedle therapy. The treatment effect, skin quality, treatment compliance and recurrence rate were compared between the two groups. Results The total effective rate of treatment in the study group (100.00%) was higher than that in the control group (85.00%) (P <0.05). After treatment, the facial skin oil content, pore severity and skin roughness in the study group were lower than those in the control group, and the skin moisture content was higher than that in the control group (P <0.05). The total treatment compliance rate of the study group (97.50%) was higher and the recurrence rate (2.50%) was lower than those of the control group (82.50%, 17.50%) (P <0.05). Conclusion For patients with refractory acne, facial chemical peeling combined with microneedle therapy can effectively improve clinical efficacy, optimize skin quality, and enhance treatment compliance, with a low recurrence rate. It is worthy of clinical application.