Objective To explore the effect of TCM acupuncture combined with Chinese herbal medicine treatment on skin barrier function in patients with facial dermatitis and sensitive skin. Methods A total of 88 patients with facial dermatitis and sensitive skin who were treated in the Department of Dermatology, the Third Affiliated Hospital of Chengdu University of Traditional Chinese Medicine from August 2022 to August 2025 were selected. According to the random number table method, they were divided into the control group and the observation group, with 44 patients in each group. The control group was given Chinese herbal medicine treatment, and the observation group was given TCM acupuncture combined with Chinese herbal medicine treatment. The symptom scores, skin barrier function, clinical efficacy and adverse reaction rate were compared between the two groups. Results After treatment, the scores of erythema, pruritus, dryness and desquamation in the observation group were all lower than those in the control group (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). The total effective rate of the observation group (97.73%) was higher than that of the control group (84.09%) (P <0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups (P >0.05). Conclusion TCM acupuncture combined with Chinese herbal medicine has a good effect in improving clinical symptoms and promoting skin barrier repair in the treatment of facial dermatitis and sensitive skin. Its curative effect is superior to that of single Chinese herbal medicine oral therapy, and it has good safety.