Objective To investigate the clinical effect of fire needle, supramolecular salicylic acid and minocycline in the treatment of moderate to severe acne. Methods A total of 60 patients with moderate to severe acne admitted to Tianjin Beichen Hospital from June 2022 to February 2023 were selected as the research objects. According to different treatment methods, they were divided into observation group A, observation group B and control group, with 20 patients in each group. The control group was treated with minocycline hydrochloride capsules, the observation group A was treated with supramolecular salicylic acid combined with minocycline hydrochloride capsules, while the observation group B was treated with fire needle, supramolecular salicylic acid combined with minocycline hydrochloride capsules. The skin lesion regression time, acne improvement and clinical efficacy of the three groups were compared. Results The regression time of skin lesions in observation group B was shorter than that in observation group A and control group, and the regression time of skin lesions in observation group A was shorter than that in control group (P<0.05). After treatment, the acne severity score of the observation group B was smaller than that of the observation group A and the control group, and that in the observation group A was smaller than that in the control group (P<0.05). The total effective rate of clinical treatment in the observation group B (100.00%) was higher than that in the observation group A (85.00%) and the control group (75.00%), and that in the observation group A was higher than that in the control group (P<0.05). Conclusion The combination of fire needle, supramolecular salicylic acid and minocycline in the treatment of patients with moderate to severe acne can effectively improve the clinical symptoms and clinical treatment effect, which is worthy of clinical application.