Objective To explore the effect of fire needle therapy based on traditional Chinese medicine dermatology on acne lesion count and acne severity in patients with acne. Methods A total of 100 patients with acne admitted to the Department of Traditional Chinese Medicine Dermatology, Jiuquan Second People's Hospital from December 2021 to December 2023 were selected. According to the random number table method, they were divided into the control group and the study group, with 50 patients in each group. The control group was treated with conventional western medicine, and the study group was treated with fire needle therapy based on traditional Chinese medicine dermatology. The acne lesion count, acne severity, sebum secretion, quality of life and facial aesthetic satisfaction were compared between the two groups. Results After 8 weeks of treatment, the acne lesion count and IGA score in the two groups were lower than those before treatment, and those in the study group were lower than those in the control group (P <0.05). After 8 weeks of treatment, the sebum secretion in the two groups was lower than that before treatment, and that in the study group was lower than that in the control group (P <0.05). After 8 weeks of treatment, the DLQI score in the two groups was lower than that before treatment, and that in the study group was lower than that in the control group (P <0.05). After 8 weeks of treatment, the facial aesthetic satisfaction score in the two groups was higher than that before treatment, and that in the study group was higher than that in the control group (P <0.05). Conclusion Fire needle therapy based on traditional Chinese medicine dermatology can effectively reduce the number of acne lesions, decrease acne severity, improve sebum secretion, and enhance patients' quality of life and facial aesthetic satisfaction, which is worthy of clinical application.