Objective To analyze the effect of fire needle combined with APT 420 nm intensive pulsed light on patients with moderate to severe acne on the face. Methods Sixty patients with moderate to severe acne admitted to our hospital from July 2022 to May 2023 were selected as the research objects. They were divided into control group and observation group by random number table method, with 30 patients in each group. The control group was treated with APT 420 nm intensive pulsed light, and the observation group was treated with fire needle combined with APT 420 nm intensive pulsed light. The clinical efficacy, skin lesions and quality of life were compared between the two groups. Results The total effective rate of treatment in the observation group was 93.33%, which was higher than 73.33% in the control group, and the difference was statistically significant (P<0.05). After treatment, the skin lesion score of the observation group was lower than that of the control group, and the difference was statistically significant (P<0.05). The scores of quality of life in the observation group were higher than those in the control group, and the differences were statistically significant (P<0.05). Conclusion The clinical effect of fire needle combined with APT 420 nm intensive pulsed light in the treatment of moderate to severe acne on the face is good, which can effectively improve the acne symptoms and promote the recovery of skin lesions. Meanwhile, it has positive significance for comprehensively improving their quality of life and is worthy of clinical application.