Objective To explore the efficacy and safety of gold microneedle in the treatment of moderate facial acne. Methods A total of 40 patients with moderate facial acne admitted to the Department of Dermatology of Zhangjiagang First People’s Hospital from February 2025 to February 2026 were selected, and they were divided into the control group and the observation group by the random number table method, with 20 patients in each group. The control group was treated with red and blue light combined with acne needle-cleaning, and the observation group was treated with gold microneedle. The clinical efficacy, acne severity, aesthetic improvement effect and adverse reaction rate were compared between the two groups. Results The total effective rate of treatment in the observation group was 90.00%, which was higher than 60.00% in the control group (P <0.05). After 8 weeks of treatment, the acne severity score of the observation group was lower than that of the control group, and the GAIS score was higher than that of the control group (P <0.05). The incidence of adverse reactions in the observation group was 25.00%, which was higher than 10.00% in the control group, but the difference was not statistically significant (P >0.05). Conclusion Gold microneedle achieves definite therapeutic effect in moderate facial acne. It can improve facial lesions and facial aesthetic effects, without increasing the risk of adverse reactions.